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Mindfulness-based interventions have been heralded as promising means of alleviating chronic stress. While meta-analyses indicate that mindfulness-based interventions significantly reduce global measures of stress, how mindfulness-based interventions modulate the specific mechanisms underpinning chronic stress as operationalized by the National Institute of Mental Health research domain criteria (RDoC) of sustained threat has not yet been detailed in the literature. To address this knowledge gap, this article aims to (1) review evidence that mindfulness-based interventions ameliorate each of the 10 elements of behavioral dysregulation characterizing sustained threat via an array of mindful counter-regulatory strategies; (2) review evidence that mindfulness-based interventions modify biological domains implicated in sustained threat, such as the hypothalamic-pituitary-adrenal axis, as well as brain circuits involved in attentional function, limbic reactivity, habit behavior, and the default mode network; and (3) integrate these findings into a novel conceptual framework of mindful self-regulation in the face of stress-the Mindfulness-to-Meaning Theory. Taken together, the extant body of scientific evidence suggests that the practice of mindfulness enhances a range biobehavioral factors implicated in adaptive stress coping and induces self-referential plasticity, leading to the ability to find meaning in adversity. These mechanistic findings can inform the treatment development process to optimize the next generation of mindfulness-based interventions for greater therapeutic efficacy.
Exposure to traumatic events often results in severe distress which may elicit self-medication behaviors. Yet, some individuals exposed to trauma do not develop post-traumatic stress symptoms and comorbid addictive impulses. In the wake of traumatic events, psychological processes like thought suppression and mindfulness may modulate post-traumatic stress and craving for substances. We examined the differential roles of mindfulness and suppression in comorbid post-traumatic stress and craving among a sample of 125 persons with extensive trauma histories and psychiatric symptoms in residential treatment for substance dependence. Results indicated that thought suppression, rather than extent of trauma history, significantly predicted post-traumatic stress symptom severity while dispositional mindfulness significantly predicted both post-traumatic stress symptoms and craving. In multiple regression models, mindfulness and thought suppression combined explained nearly half of the variance in post-traumatic stress symptoms and one-quarter of the variance in substance craving. Moreover, multivariate path analysis indicated that prior traumatic experience was associated with greater thought suppression, which in turn was correlated with increased post-traumatic stress symptoms and drug craving, whereas dispositional mindfulness was associated with decreased suppression, post-traumatic stress, and craving. The maladaptive strategy of thought suppression appears to be linked with adverse psychological consequences of traumatic life events. In contrast, dispositional mindfulness appears to be a protective factor that buffers individuals from experiencing more severe post-traumatic stress symptoms and craving.
Stress-related illness presents an ever-increasing burden to society, and thus has become the target of numerous complementary and integrative medicine interventions. One such clinical intervention, mindfulness meditation, has gained eminence for its demonstrated efficacy in reducing stress and improving health outcomes. Despite its prominence, little is known about the mechanics through which it exerts its treatment effects. This article details the therapeutic mechanisms of mindfulness with a novel causal model of stress, metacognition, and coping. Mindfulness is hypothesized to bolster coping processes by augmenting positive reappraisal, mitigating catastrophizing, and engendering self-transcendence. Reviews of stress and mindfulness are then framed by the perspective of second-order cybernetics, a transdisciplinary conceptual framework which builds on extant theory by highlighting the recursion between the individual and their environment.
In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.
The stress-reductive effect of mindfulness practice is well-established, yet less is known about the cognitive mechanisms underlying this salutary outcome. We conducted a prospective observational study of 339 participants (mean age 45.7 ± 13.4) undergoing an 8-week mindfulness-based stress and pain management course and found support for our hypotheses that a) pre-post intervention increases in dispositional mindfulness are reciprocally linked with increases in positive reappraisal coping and b) the stress-reductive effects of increases in dispositional mindfulness are mediated by increases in positive reappraisal independent of changes in catastrophizing. Positive reappraisal and mindfulness appear to serially and mutually enhance one another, creating the dynamics of an upward spiral. Through mindfulness practice, individuals may engender a broadened state of awareness that facilitates empowering interpretations of stressful life events, leading to substantially reduced distress. Study findings have implications for cognitive therapy that couples mindfulness practices with restructuring techniques oriented toward benefit finding and positive reappraisal.
OBJECTIVE: A growing body of theoretical and empirical work suggests that mindfulness may support more positive posttraumatic outcomes by reducing posttraumatic stress (PTS) and encouraging posttraumatic growth (PTG). Positive reappraisal (PR), a cognitive coping correlate of dispositional mindfulness (DM) has also been linked with greater PTG. However, neither DM nor PR have been modeled in relation to core posttraumatic constructs such as core belief disruption, intrusive rumination, deliberate rumination, PTS and PTG. METHOD: This study explored associations between these constructs in a sample of college students (N = 505), also investigating the impact of contemplative practice involvement on the relationships between the constructs. RESULTS: Results indicate that including DM and PR into established models of PTG increases the model's explanatory power, which distinct cognitive coping pathways connect DM and core belief disruption with PTS as well as PTG, and that contemplative practice involvement substantially alters relationships between the core PTG variables. CONCLUSIONS: The present study contributes to the growing reconceptualization of trauma as linked with both positive and pathogenic outcomes, emphasizing the need to better understand how posttraumatic cognitive coping strategies contribute to more positive outcomes. (PsycINFO Database Record
OBJECTIVE: A growing body of theoretical and empirical work suggests that mindfulness may support more positive posttraumatic outcomes by reducing posttraumatic stress (PTS) and encouraging posttraumatic growth (PTG). Positive reappraisal (PR), a cognitive coping correlate of dispositional mindfulness (DM) has also been linked with greater PTG. However, neither DM nor PR have been modeled in relation to core posttraumatic constructs such as core belief disruption, intrusive rumination, deliberate rumination, PTS and PTG. METHOD: This study explored associations between these constructs in a sample of college students (N = 505), also investigating the impact of contemplative practice involvement on the relationships between the constructs. RESULTS: Results indicate that including DM and PR into established models of PTG increases the model's explanatory power, which distinct cognitive coping pathways connect DM and core belief disruption with PTS as well as PTG, and that contemplative practice involvement substantially alters relationships between the core PTG variables. CONCLUSIONS: The present study contributes to the growing reconceptualization of trauma as linked with both positive and pathogenic outcomes, emphasizing the need to better understand how posttraumatic cognitive coping strategies contribute to more positive outcomes. (PsycINFO Database Record