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RUNNING HEAD: MINDFULNESS TRAINING AND STRESS
Brief Mindfulness Meditation Training alters Psychological and Neuroendocrine Responses
to Social Evaluative Stress
J. David Creswella, Ph.D.
Laura E. Pacilioa, B.S.
Emily K. Lindsaya, M.S.
Kirk Warren Brownb, Ph.D.
aCarnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
bVirginia Commonwealth University, 806 West Franklin St, Richmond, VA, 23284-2018, USA
[in press, Psychoneuroendocrinology]
Conflicts of Interest and Source of Funding: This research was supported by the Pittsburgh
Life Sciences Greenhouse Opportunity Fund. The authors report no conflicts of interest.
Corresponding Author: J. David Creswell, Associate Professor in Psychology, Carnegie Mellon
University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
Email: creswell@cmu.edu.
Phone: 412-268-9182. Fax: 412-268-2798
Number of Tables: 1 Number of Figures: 5
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Abstract
Objective: To test whether a brief mindfulness meditation training intervention buffers self-
reported psychological and neuroendocrine responses to the Trier Social Stress Test (TSST) in
young adult volunteers. A second objective evaluates whether pre-existing levels of dispositional
mindfulness moderate the effects of brief mindfulness meditation training on stress reactivity.
Methods: Sixty-six (N=66) participants were randomly assigned to either a brief 3-day (25-
minutes per day) mindfulness meditation training or an analytic cognitive training control
program. All participants completed a standardized laboratory social-evaluative stress challenge
task (the TSST) following the third mindfulness meditation or cognitive training session.
Measures of psychological (stress perceptions) and biological (salivary cortisol, blood pressure)
stress reactivity were collected during the social evaluative stress-challenge session.
Results: Brief mindfulness meditation training reduced self-reported psychological stress
reactivity but increased salivary cortisol reactivity to the TSST, relative to the cognitive training
comparison program. Participants who were low in pre-existing levels of dispositional
mindfulness and then received mindfulness meditation training had the greatest cortisol
reactivity to the TSST. No significant main or interactive effects were observed for systolic or
diastolic blood pressure reactivity to the TSST.
Conclusions: The present study provides an initial indication that brief mindfulness meditation
training buffers self-reported psychological stress reactivity, but also increases cortisol reactivity
to social evaluative stress. This pattern may indicate that initially brief mindfulness meditation
training fosters greater active coping efforts, resulting in reduced psychological stress appraisals
and greater cortisol reactivity during social evaluative stressors.
Keywords: mindfulness; meditation; stress; Trier Social Stress Test
Abbreviations: SBP = Systolic Blood Pressure, DBP = Diastolic Blood Pressure, TSST =
Trier Social Stress Task, MLM = Mixed Effect Linear Model, ANOVA = Analysis of
Variance, AUC_I = area under the curve with respect to increase, RCT = Randomized
Controlled Trial, HIV = Human Immunodeficiency Virus, MAAS = Mindful Attention
Awareness Scale, MBSR = Mindfulness-Based Stress Reduction, HPA = Hypothalmic-
Pituitary-Adrenal, SMA = Sympathetic-Adrenal Medullary
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Brief Mindfulness Meditation Training alters Psychological and Neuroendocrine Responses
to Social Evaluative Stress
Over the last fifteen years, there has been a dramatic increase in research and public
interest in mindfulness meditation training. This interest has largely focused on using
mindfulness meditation training to foster well-being and improve mental and physical health
outcomes (Brown et al., 2007; Ludwig and Kabat-Zinn, 2008). For example, randomized
controlled trials (RCTs) show that mindfulness meditation training buffers HIV-pathogenesis in
HIV-positive adults (Creswell et al., 2009; SeyedAlinaghi et al., 2012), accelerates skin clearing
rates in psoriasis patients (Bernhard et al., 1988; Kabat-Zinn et al., 1998), reduces risk for
depression relapse in at-risk patient populations (Ma and Teasdale, 2004; Teasdale et al., 2000),
decreases pain symptomatology (Kabat-Zinn, 1982; Zeidan et al., 2011), and reduces markers of
inflammatory disease risk (e.g., C Reactive Protein) (Creswell et al., 2012; Malarkey et al.,
2013). This emerging research base indicates that mindfulness meditation training may have
beneficial effects across a spectrum of health conditions, but the mechanisms linking
mindfulness meditation training with health are unknown. The stress buffering hypothesis,
initially described in the social support literature (e.g., Cohen and Wills, 1985), is described as a
potential pathway linking mindfulness meditation training with health (Brown et al., 2012;
Creswell, 2014). Specifically, this stress buffering hypothesis posits that mindfulness meditation
training effects on health may, in part, be explained by the capacity of mindfulness meditation
training to foster resilience to stress (Creswell, 2014). The present study describes the first well-
controlled experimental test of mindfulness meditation training and changes in self-reported
psychological and neuroendocrine stress reactivity to the Trier Social Stress Test (TSST).
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It is well known that repeated, excessive, or prolonged stress reactivity can increase one’s
health risks (Cohen et al., 2002, 2007; McEwen, 1998). One striking feature of the mindfulness
training literature to-date is that mindfulness training effects on disease outcomes have been
observed in diseases where stress is known to trigger the onset or exacerbation of disease
symptoms and pathogenesis (e.g., HIV, psoriasis, depression, pain, chronic inflammation)
(Cohen et al., 2007). One possibility, then, is that mindfulness meditation training may facilitate
reduced stress reactivity and resilience in at-risk stressed patient populations, and that this stress
resilience may buffer or reverse stress-related disease outcomes. Although the stress buffering
account of mindfulness meditation training has been offered in several theoretical accounts and
reviews of the mindfulness literature (Creswell, 2014; Ludwig and Kabat-Zinn, 2008), very little
experimental work has directly tested whether mindfulness training reduces psychological and
biological stress reactivity under controlled conditions. In support of the stress buffering account,
two recent correlational studies show that greater self-reported dispositional mindfulness is
associated with reduced self-reported psychological responses and biological stress reactivity to
physical (Arch and Craske, 2010) and social (Brown et al., 2012) (cf. Barnes et al., 2007;
Skinner et al., 2008) laboratory stressors. For example, Brown and colleagues found that
dispositional mindfulness (measured by the Mindful Attention and Awareness Scale (MAAS),
which measures sustained, receptive attentiveness to daily life experiences) was associated with
reduced negative affect and salivary cortisol responses to the TSST, but was not associated with
these stress markers under a low stress TSST control task (Brown et al., 2012). More recently,
two RCTs of Mindfulness-Based Stress Reduction (MBSR) training provide initial evidence that
eight weeks of mindfulness training can reduce blood pressure reactivity to the TSST in high
stress community adults (Nyklíček et al., 2013) and self-reported stress perceptions to the TSST
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in patients with generalized anxiety (Hoge et al., 2013), but notably two recent studies also
showed no effects of MBSR training on buffering cortisol reactivity to the TSST (Nyklíček et al.,
2013; Rosenkranz et al., 2013).
Although recent studies provide an initial indication that dispositional mindfulness and
mindfulness meditation training may reduce stress reactivity, there are several important
unknowns that the present study will address. First, it is unclear whether mindfulness meditation
training reduces stress reactivity compared to other active cognitive training programs. An active
control program is important because it is currently unclear whether it is the specific capacity for
developing a non-evaluative attention and awareness to present experience in mindfulness
meditation training that fosters stress resilience, as opposed to general attention training and
cognitive skill learning, which can buffer stress reactivity (Gaab et al., 2003). To test this, the
present study compares mindfulness meditation training to an analytic cognitive training control
program, and includes assessments of whether this active comparator is well-matched on
attentiveness and positive treatment expectancies.
Second, it is unclear whether small doses of mindfulness meditation training are
sufficient for increasing stress resilience. Previous RCT studies have described how an intensive
8-week MBSR program may reduce stress reactivity (Hoge et al., 2013; Nyklíček et al., 2013),
but several studies show that just three or four days of 20-minute mindfulness meditation training
can increase analgesia to stimulated pain (Zeidan et al., 2011, 2010). Moreover, these (and other)
initial studies indicate that pre-recorded audio mindfulness interventions can be efficacious (e.g.,
Cavanagh et al., 2013; Morledge et al., 2013; Zautra et al., 2012). The present study tests
whether three consecutive days of 25-minute audio-guided mindfulness meditation (vs. control)
training in meditation naïve participants reduces stress reactivity to the TSST.
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Finally, no studies have tested whether there are interactive effects of pre-existing
dispositional mindfulness and mindfulness meditation training on stress reactivity. One recent
study suggests that more dispositionally mindful participants are more responsive to training,
showing greater increases in subjective well-being and decreases in stress symptoms after eight
weeks of mindfulness training (Shapiro et al., 2011). The present study is the first to test for
interactive effects of dispositional mindfulness and brief mindfulness training on stress reactivity
to the TSST. This investigation of moderation has practical value: it can determine whether
certain individuals respond to mindfulness training to a greater or lesser degree than others.
We tested two primary predictions in the present study. First, it was hypothesized that
three days of mindfulness meditation training (compared to an active cognitive comparison
training) would reduce self-reported psychological and neuroendocrine stress reactivity to the
TSST. Second, it was hypothesized that dispositional mindfulness would moderate these effects
of mindfulness training, such that participants higher in dispositional mindfulness who received
three days of mindfulness meditation training would have lower stress reactivity to the TSST.
Method
Participants
We recruited 73 healthy male and female students from the Carnegie Mellon University
and University of Pittsburgh campus communities. Inclusion criteria for study participation were
being between the ages of 18-30 years, being mentally and physically healthy (i.e., no medical
diagnosis of any ongoing disease), and not currently taking any form of oral contraceptive (i.e.,
birth control). We excluded one participant who was administered the wrong study training on
Day 2 and three participants who elected to discontinue study participation before the Day 3
experimental session. Also, three outlier participants with extreme dispositional mindfulness
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scores (+/- 2 SDs from the sample mean) were excluded. Study analyses are reported on 66
participants (31 participants in mindfulness training group, 35 in attention control training).
The average age of participants was 21.70 years (SD=2.91) and 59% were male. The
ethnic breakdown of participants was 33.3% Caucasian, 31.8% Asian American, 9.1% Latino,
4.5% African American, and 21.2% Other. All study procedures were approved by the Carnegie
Mellon Institutional Review Board. All study data was collected between August 2012 and April
2013.
Procedure
Overview. Figure 1 provides an overview of the study procedures. Participants were
recruited for a three-day study testing how attention training impacts performance. To minimize
potential expectancy and other biases, there was no mention of ‘meditation training’ in study
advertisements or screening/informed consent. The experimental sessions were conducted on
three consecutive days. Participants arrived for study sessions one at a time, and were randomly
assigned on day one to either a three-day mindfulness meditation training group or a matched
three day cognitive training control group, which consisted of developing critical thinking skills
by analyzing poetry passages. After completing their training on day three, all participants
completed the TSST.
Day One & Two Procedure. Upon arrival on day one, participants provided written
informed consent and completed individual difference measures, which included a measure
assessing prior experience with meditation or mind-body practices and a 15-item unidimensional
measure of dispositional mindfulness (see Measures) (Brown and Ryan, 2003). Participants
were then instructed and guided through their assigned training program (delivered using
prerecorded audio files via PC computer and headphones) (see Training Interventions). During
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each day’s training exercise, participants were probed on how attentive they were to task
instructions (see Measures). To enable experimenter blinding to study condition, the
experimenter launched audio files labeled as “1” or “2” followed by the session number on a PC
computer. Participants completed their training in a laboratory room. The experimenter
monitored participants from an adjacent room during the training to ensure that participants were
engaged (e.g., not sleeping) during the trainings. If participants appeared to be off-task, the
experimenter re-entered the room to remind participants to actively participate in the training.
Each audio training session was 25 minutes, after which participants completed a brief
questionnaire assessing their reactions to the training exercise (see Measures). This training
protocol was repeated on day two.
Day Three Procedure. To control for diurnal variation in cortisol, all participants
completed their third study session between 1400h and 1900h. Upon arriving, participants
completed demographic and health questionnaires. A blood pressure cuff was applied to measure
cardiovascular responses to the study tasks, and the experimenter took a five minute baseline
blood pressure reading. Participants provided a saliva sample for baseline cortisol 35 minutes
after arriving for the experimental session. Participants then heard pre-recorded instructions
explaining the upcoming speech performance activity and were given three minutes to mentally
prepare. Next, participants completed a third session of attention training.
Then, following general guidelines for conducting the TSST (Kirschbaum et al., 1993),
participants were seated in front of two evaluators trained to be cold and non-accepting. They
first gave a five-minute speech addressing why they would be a good administrative assistant for
a hypothetical job in the department, and then completed five minutes of difficult mental
arithmetic (specifically, counting backwards from 2083 by 17’s). The evaluators interrupted
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participants during the speech task to ask critical questions and during the arithmetic task to
point out mistakes and instruct participants to restart counting from 2083. The evaluators also
instructed participants on several occasions to sit as still as possible in the chair and to maintain
eye contact throughout the speech and arithmetic tasks. We (and others) have used these
procedures for reliably eliciting group-level increases in sympathetic-adrenal-medullary (SAM)
and hypothalamic-pituitary-adrenal (HPA) axis activation (Creswell et al., 2013, 2005;
Dickerson and Kemeny, 2004). To assess psychological stress perceptions during the math and
speech tasks, participants were asked to complete self-report visual analogue scale items
immediately after the speech task and again after the math task (see Measures) (Hellhammer and
Schubert, 2012).
To measure peak cortisol responses to the TSST, saliva samples were acquired at 25 and
35 minutes after the start of the task (Dickerson and Kemeny, 2004). Participants were then
probed for suspicion of the evaluators using a funnel debriefing, and informed of the primary
study aim (to explore how attention training impacts stress responding). To reduce potential
distress, participants were given performance feedback that the tasks were designed to be
stressful and that their performance was normative. A final saliva sample was taken at the
conclusion of the study (60 minutes after the start of the performance task).
Training Interventions. Training consisted of three 25-minute audio-guided exercises.
The training sessions were designed to be well-matched on attention training demand and
instructor contact (the same female voice narrated all study audio training). Word count and
timing of instructions and silent rest periods were matched between the two three-day training
programs.
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Mindfulness Training: The mindfulness training scripts were adapted from 3-4 day
mindfulness training interventions used previously in studies of mindfulness training and pain
(Zeidan et al., 2011, 2010). Participants were told that they would participate in training designed
to foster attention and awareness to present-moment experience. Instructions in the first session
focused around breath awareness: labeling inhales and exhales, noting the sensations and
subtleties of the full breath cycle, and noticing mental distractions and mind-wandering away
from the breath. The second session reviewed breath awareness and progressed to full body
awareness, guiding participants through a body scan. In the final session, participants again
practiced breath and body awareness, and concluded with open awareness of emotions and
thoughts in conjunction with breath and body awareness.
Analytic Cognitive Control Training: Participants in the analytic cognitive control
training condition were told that they would be receiving training that would teach them how to
develop an analytical focus for effective problem-solving. Each session consisted of a series of
poems that the narrator first read and then instructed the participant on how to analyze quietly
(these silent periods were included as a match for the periods of silent meditation in the
experimental sessions, and at three time points in each session, all participants were probed for
attentiveness). To mirror the progression of meditation exercises in the mindfulness trainings,
the sessions progressed in analytical complexity from noticing the structure of the poems (day
one), to structure and imagery (day two), to analyzing their symbolism and deeper meanings (day
three).
Measures
Task Engagement. To test whether attention to task instructions was equivalent
between the mindfulness and control conditions, participants were asked to rate their lack of
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attentiveness three times during each attention training session, following procedures for
assessing probe-caught mind wandering described in Mrazek et al (2012). At the sound of a
chime, participants were asked to rate how inattentive they were to the task instructions from 1
(completely on task) to 5 (completely focused on task-unrelated concerns), where higher ratings
indicated less attentiveness to task instructions. The three chimes were pre-recorded so that all
participants rated their attentiveness at the same time in a particular training session. The three
ratings were summed to produce a total inattentiveness score for each day of training.
Training Expectancy. Directly after each training session, participants were given a
four-item questionnaire assessing their beliefs about the efficacy and relevancy of the training on
a scale from 1 (Not at all) to 9 (Very Much). Two thinking and two feeling items were adapted
from the Credibility/Expectancy Questionnaire (Devilly and Borkovec, 2000) for the present
study. They were: “At this point, how logical does the attention training offered to you seem?”;
“How confident would you be in recommending this attention training program to a friend who
wants to improve their attentional focus?”; “At this point, how much do you feel that attention
training will help your cognitive performance at the end of the study?”; “How much do you feel
that the techniques you learn in this program will be worth your time and effort?”. Higher scores
refer to greater positive expectancies about the perceived benefits of their training for
performance. The four questions were summed to produce a composite training expectancy score
for each day of the training: day one Cronbach’s α = .88, day two α = .92, day three α = .93.
Dispositional Mindfulness. On day one prior to training, participants completed the 15-
item Mindful Attention Awareness Scale (Brown and Ryan, 2003) which asks participants to rate
the degree to which they are attentive to and aware of present moment experience, e.g., “I find it
difficult to stay focused on what’s happening in the present,” on a scale from 1 (Almost Never)
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to 6 (Almost Always). We made one change to scale administration to facilitate ease of
completing questionnaire items: we anchored the scale such that higher raw scores indicated
lower levels of mindfulness, and we then reverse-scored all items so that in all reported analyses,
higher scores indicate greater levels of dispositional mindfulness. Individual items were
averaged to create a composite dispositional mindfulness score (Cronbach’s α = .76).
Stress Perceptions. Participants were asked to indicate their stress perceptions
immediately following the five-minute speech (and before commencing the math task), and
again immediately following the five-minute math task using visual analog scales (following
procedures described in Hellhammer and Schubert, 2012). Participants placed a slash mark on a
bipolar, 140mm line to indicate how stressed, anxious, and insecure they felt from 0 (Not at all)
to 140 (Highly). We used the distance of the slash marks (in centimeters) from the beginning of
the line to create numerical values, where a greater number of centimeters indicated higher levels
of stress perceptions during the speech and math tasks. Ratings from both the speech and
counting task were summed to create a composite measure of overall stress perceptions during
the TSST (Cronbach’s α = .89).
Cortisol and Cardiovascular Measures
Salivary cortisol was collected using a Salivette (Rommelsdorf, Germany). All Salivettes
were frozen at -20º Celsius in a locked and secure laboratory freezer. Participants kept the
Salivette under their tongue for two minutes during each collection period and did not touch the
sample with their hands. At the conclusion of the experiment, the samples were shipped on dry
ice to a professional laboratory in Dresden, Germany specializing in cortisol measurement. At
this laboratory, cortisol was measured using a chemoluminescence-immuno-assay with high
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sensitivity (IBL International, Hamburg, Germany). Intra- and inter-assay coefficients of
variation from this laboratory are typically below 10%.
A measure of oscillometric blood pressure was collected using an automatic
sphygmomanometer (Dinamap Carescape V100, General Electric Company, GE, Finland).
Systolic (SBP) and diastolic (DBP) blood pressure were recorded with this device at 2-minute
intervals. Averages of these 2-minute readings were calculated during the 5-minute baseline
epoch, the 3-minute speech preparation epoch, the 25-minute attention training epoch, the 12-
minute performance epoch during the stress task, and a 5-minute recovery epoch directly after
the stress task. Participants remained seated during the collection of all cortisol and
cardiovascular measures.
Statistical Data Analysis
All analyses were conducted with the SPSS 20.0 software package (IBM, Armonk, New
York). The training condition variable was dummy-coded as 1=mindfulness training; 0=control
training. Preliminary analyses evaluated success of randomization (using chi-square and
independent-samples t-tests), tested for baseline to peak stress increases in the total sample
(using paired-sample t-tests), and tested for associations between treatment expectancies,
psychological stress perceptions, and biological stress reactivity (using Pearson’s correlations).
Preliminary analyses also evaluated whether the control training program was effective at
controlling for attention and expectancies across the three training days, using mixed effect linear
models (MLMs) and independent samples t-tests. MLMs, which are robust to missing data
(relative to listwise deletion of subjects in repeated measures ANOVAs), were used for study
analyses that included a within-subjects variable (i.e., time). Participants who had partial missing
data over time were still included in MLM analyses, following intent-to-treat principles. In all
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MLMs, variables of interest were modeled as fixed effects using maximum likelihood
estimation. All MLMs modeled the repeated measures variable (time) with a compound
symmetry covariance structure, and the baseline (pre-stress) value was included as the first time
point testing for linear time interactions with predictor variables of interest (e.g., condition,
dispositional mindfulness).
Primary stress reactivity analyses were implemented in two steps. First, multiple
regression analyses were conducted to test for condition differences and dispositional
mindfulness moderated condition effects on psychological stress reactivity, and area-under-the-
curve with respect to increase (AUC-I) cortisol stress reactivity to the TSST. The AUC-I cortisol
measure was calculated using Pruessner's trapezoid formula (Pruessner et al., 2003), using the
following equation: AUC_I=((Cortisol time 1 + Cortisol time 2) / 2 * 70 + (Cortisol time 2 +
Cortisol time 3) / 2 * 10 + (Cortisol time 3 + Cortisol time 4) / 2 * 25) - (Cortisol time 1 * (70 +
10 + 25)). Note that the AUC-I result subtracts out the baseline (or ground) cortisol level; thus
AUC-I measures cortisol reactivity to the TSST. In cases where a participant was missing a
cortisol time point value (1.5% of the total number of salivary cortisol samples were missing in
this study), mean replacement (i.e., the series mean) was used in order to calculate a total AUC-I
for each participant. Second, we conducted a follow-up MLM analysis of the AUC-I cortisol
reactivity effect, permitting us to examine the cortisol reactivity effect over time. Due to a
computer malfunction, we were unable to collect one subject’s dispositional mindfulness data.
This subject is included in our final sample but excluded from analyses that include the
dispositional mindfulness moderator variable.
Results
Preliminary Analyses
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Randomization was successful in equalizing the mindfulness and cognitive training
control groups at baseline; they did not differ significantly on age (t(64)=-.05, p=.96), gender
(χ2(1)=1.81, p=.18), ethnicity (χ2(4)=5.89, p=.21), prior exposure to meditation or mind-body
practices (χ2(1)=.33, p=.57), or day one dispositional mindfulness (t(63)=-1.36, p=.18). Likewise,
on the day three TSST session, there were no group differences in time of day of first cortisol
sample (t(64)=-.43, p=.67).
Did the TSST procedure effectively produce a stress response? Paired-samples t-tests
confirmed that there was a significant increase in cortisol from baseline to peak reactivity (25
minutes post-stress task onset) (t(65)=-4.06, p=<.001) in the total sample. Similarly, there were
significant increases from baseline to the stress task in systolic blood pressure (t(60)=-18.97,
p=<.001) and in diastolic blood pressure (t(60)=-22.03, p=<.001). Was there a significant
association between treatment expectancies and stress? There was no association between
treatment expectancies and measures of self-reported psychological stress reactivity (r(64))=-.07,
p=.56) or AUC-I salivary cortisol reactivity to the TSST (r(64)=-.07, p=.56). Did psychological
stress reactivity co-vary with cortisol reactivity? There was also no association between AUC-I
cortisol reactivity and self-reported psychological stress perceptions to the TSST (r(64)=-.15,
p=.22).
Did the analytic control training effectively control for task engagement compared to
mindfulness meditation training? Participants in both groups indicated similar levels of task
engagement during the training tasks. Specifically, an MLM showed no main effect of study
condition (F(1,66)=.47, p=.50); participants in the mindfulness group (M[SE]=2.36[.12]) were
similarly attentive to participants in the control group (M[SE]=2.47[.12]). This analysis also
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showed no condition ×time interaction (F(2,132)=1.84, p=.16) indicating that participants in
both conditions were also similarly task engaged across all three training days.
Did the analytic control training effectively control for positive treatment expectancies
compared to the mindfulness meditation training after the three days of training? An
independent samples t-test indicated that mindfulness meditation training group had significantly
higher positive treatment expectancies upon completion of training (on day three) compared to
the analytic control training program group (t(64)=2.89, p=.005 (mindfulness training group
M=6.10[.31], control training group: M=4.95[.25])). Given this significant difference, day three
training expectancies was included as a covariate in all psychological and salivary cortisol stress
reactivity analyses.
Psychological Stress Perceptions
We tested two predictions: first, that brief mindfulness meditation training reduces stress
reactivity, and second, that this main effect of mindfulness meditation training would be
moderated by dispositional mindfulness. To test these predictions, we conducted a multiple
regression analysis that tested for main and interactive effects of three day training and
dispositional mindfulness on self-reported psychological stress perceptions to the TSST
performance tasks (controlling for day three expectancies). We observed a significant main
effect for three day mindfulness training (β=-1.98, t(4)=-2.13, p=.038), a significant main effect
for dispositional mindfulness (β=-.40, t(4)=-2.54, p=.01), and a significant training condition ×
dispositional mindfulness interaction (β= 1.89, t(4)=2.02, p=.048) on stress perceptions. As
shown in Figure 2, (1) participants in the mindfulness training group had significantly lower
stress perceptions compared to the control group, (2) participants higher in dispositional
mindfulness had lower stress perceptions, and (3) these main effects were qualified by their
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interaction: participants in the control training program who were low in dispositional
mindfulness had the greatest psychological stress perceptions to the TSST. Specifically,
receiving mindfulness training or reporting higher dispositional mindfulness (or having both
mindfulness training and high dispositional mindfulness) buffered self-reported psychological
stress responses to the TSST.
Physiological Stress Reactivity
Cortisol Reactivity. A multiple regression analysis tested whether mindfulness (vs.
control) training, dispositional mindfulness, and their interaction predict AUC-I salivary cortisol
reactivity to the TSST (controlling for day three expectancies). We observed a significant main
effect for the three-day mindfulness training (vs. control training) (β=1.98, t(4)=2.10, p=.04),
such that the mindfulness training group showed significantly greater AUC-I cortisol reactivity
to the TSST compared to the control training group. No significant main effect of dispositional
mindfulness was observed (β=.15, t(4)=.941, p=.35), but there was a significant training
condition × dispositional mindfulness interaction on AUC-I cortisol reactivity to the TSST (β=-
1.85, t(4)=-1.97, p=.05).
To probe this interaction and examine how these cortisol reactivity effects occur over
time, a follow-up MLM tested the interactive effects of training condition, dispositional
mindfulness, and time on salivary cortisol response to the TSST. Like the two-way interaction
effect on AUC-I cortisol reactivity, we observed a significant three-way dispositional
mindfulness × training condition × time interaction in the MLM (controlling for day three
expectancies) (F(3,191)=4.58, p=.004). As shown in Figure 3, this interaction was driven by the
observation that participants lower in dispositional mindfulness, who then received the
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mindfulness training, had the greatest salivary cortisol reactivity responses to the TSST. The
main effect and two-way interaction results from this MLM are provided in Table 1a.
Cardiovascular Reactivity. We conducted the same follow-up MLM analyses on systolic
and diastolic blood pressure responses to the TSST. We did not observe any significant main or
interactive effects in these analyses. All results are provided in Table 1b, and the MLMs of
systolic and diastolic blood pressure are visually depicted in Figures 4 and 5.
Discussion
The present study is the first to demonstrate that a small dose of mindfulness meditation
training (75 minutes over three days) reduces self-reported psychological stress reactivity to the
TSST. Notably, this same psychological stress buffering effect was observed for participants
who had high levels of dispositional mindfulness upon study entry. These results are consistent
with previous studies indicating that eight weeks of mindfulness training or high levels of
dispositional mindfulness are associated with reduced stress perceptions to controlled laboratory
stressors (Arch and Craske, 2010; Brown et al., 2012; Hoge et al., 2013). Moreover, this study
provides novel evidence for interactive effects of brief mindfulness meditation training and
dispositional mindfulness on stress responses to the TSST: these main effects for mindfulness
meditation training and dispositional mindfulness were qualified by their interaction. We found
that participants low in mindfulness (either not receiving mindfulness meditation training or
participants who are low in dispositional mindfulness) had the greatest psychological stress
reactivity to the TSST. Although there has been recent interest in understanding whether
individuals lower or higher in dispositional mindfulness are more likely to benefit from
mindfulness meditation training, only one published study (to our knowledge) has tested for
interactive effects of dispositional mindfulness and mindfulness meditation training (Shapiro et
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
18!
al., 2011). The present findings offer a novel perspective for their interaction, namely that either
form of mindfulness (dispositional or trained) can foster psychological stress resilience.
We did not observe a significant association between self-reported psychological stress
perceptions and salivary cortisol responses to the TSST, and the mindfulness effects on salivary
cortisol reactivity to the TSST showed a different pattern from the psychological stress reactivity
effects (for a review discussing this commonly observed dissociation between psychological and
biological stress responses to acute stress-challenge tasks, see Campbell and Ehlert, 2012).
Contrary to predictions, brief three-day mindfulness meditation training increased salivary
cortisol responses to the TSST relative to the analytic cognitive training comparison group.
Moreover, this main effect of brief mindfulness meditation training was moderated by
dispositional mindfulness, such that it was the participants lower in dispositional mindfulness
who showed the greatest cortisol reactivity to the TSST after mindfulness meditation training (a
significant mindfulness training by dispositional mindfulness interaction).
One important question, then, is how brief mindfulness meditation training buffers
psychological stress perceptions but increases cortisol reactivity to the TSST. A potential
explanation for these results, to be tested in future research, is that mindfulness training fostered
more engagement and active coping during the TSST tasks—the deployment of more active
coping buffered psychological stress perceptions, but the increased coping efforts resulted in
more cortisol reactivity (Akinola and Mendes, 2012; Lam et al., 2009). Indeed, it may be that
participants who were lower in dispositional mindfulness may have had to deliberately make
extra coping efforts, resulting in the greatest cortisol reactivity to the TSST (Brown et al., 2012).
Like the effects observed here, a recent study shows that participants high in dispositional
emotion regulation capacity have reduced anxiety but greater cortisol reactivity to a social-
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
19!
evaluative speech task (Lam et al., 2009); thus it may be that mindfulness meditation training
facilitates active emotion-focused coping (e.g., cognitive reappraisal) during the TSST.
Consistent with this active emotion-focused coping account, previous studies indicate that
mindfulness training increases emotion regulation skills and fosters positive reappraisals for
stressful events (Chambers et al., 2009; Garland et al., 2011; Weinstein et al., 2009). One testable
hypothesis is that these active coping efforts may be particularly deliberate and effortful after
brief mindfulness meditation training, but then become more automatic after longer periods of
training (resulting in lower neuroendocrine stress reactivity over time) (Baer et al., 2012).
We speculate that an alternative explanation can be offered for the present findings.
Specifically, initially mindfulness meditation training increases stress reactivity by depleting
cognitive resources and that the decrease in self-reported psychological stress reactivity is merely
a demand characteristic associated with receiving a challenging body-awareness attention
training program (cf. Baer et al., 2012). This ‘resource depletion’ explanation is consistent with
some research, which shows that mindfulness meditation training, during the initial stages of
meditation skill acquisition, can be cognitively demanding (Brefczynski-Lewis et al., 2007;
Evans et al., 2014; Wadlinger and Isaacowitz, 2011), and this may be particularly pronounced for
those with lower dispositional mindfulness. Thus, initial mindfulness meditation training (such
as that found in our brief three-day training) increases positive views and treatment expectancies,
but depletes cognitive resources, resulting in an overall greater cortisol reactivity response to the
TSST (Bohnen et al., 1990). Although future studies are needed to test this resource depletion
account of brief mindfulness meditation training, we suspect that it is unlikely to completely
explain the present effects, given that previous brief mindfulness training studies suggest
enhanced self-regulatory resources (Jain et al., 2007; Moore et al., 2012; Tang et al., 2007;
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
20!
Zeidan et al., 2010). Moreover, cognitive depletion has been linked with increased negative
affect and fatigue (Hagger et al., 2010), whereas we did not find evidence consistent with this
psychological profile in the mindfulness trained group. Rather, mindfulness meditation training
in the present study lowered psychological stress perceptions of threat to the TSST, even after
controlling for group differences in positive treatment expectancies. It will be important for
future studies to carefully test these mechanistic accounts of whether mindfulness meditation
increases active emotion-focused coping (or is resource depleting), and how this may drive
changes in psychological and neuroendocrine stress reactivity to acute stressors.
The present study compared mindfulness meditation training to an active cognitive
training. Variants of this type of reading/listening training control program are increasingly used
in the mindfulness training literature as active comparison treatments (Allen et al., 2012; Koole
et al., 2009), and previous studies indicate that mindfulness and cognitive-analytic modes of
attention can be reliably distinguished (Farb et al., 2010, 2007). A careful assessment of
attentiveness during the 25-minute training periods (using probes) indicated that this active
analytic training program was effective at controlling for attention and task engagement—there
were no differences in attentiveness between the mindfulness meditation and cognitive training
groups during the 25-minute training periods. The present study is also the first to assess
differential treatment expectancies in a mindfulness meditation training active treatment
controlled trial, and we found that the mindfulness meditation training group had higher
treatment expectancies for positive performance compared to the control training group. We note
that this difference was controlled in all study analyses in the present report, thus it is not the
case that underlying differences in positive treatment expectancies explain the present stress
reactivity effects we observed. We believe our assessment of (and control for) participant
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
21!
expectancies is a strength of this study, and addresses recent calls for more rigorous evaluation of
differential expectancies generated by behavioral interventions (Boot et al., 2013). Our findings
highlight the need for future active treatment controlled trials of mindfulness meditation training
to rigorously assess treatment expectancies.
This research has several limitations. Measures of baseline perceived stress and a pre-
training TSST were not administered, thus it is unclear how mindfulness training changed stress
reactivity from pre to post-training. We note that there are significant habituation effects in stress
reactivity with repeated TSST administrations in healthy volunteers (for a review, see Kudielka
et al., 2007), which may obscure (or change the nature of) mindfulness stress buffering effects to
the TSST. This study did not include a validated state measure of mindfulness to evaluate
whether mindfulness training altered reported mindfulness after each training session, another
limitation. The blood pressure reactivity effects (see Figures 4 and 5) in the present study
followed similar patterns to cortisol reactivity (Figure 3), such that participants low in
dispositional mindfulness who received mindfulness meditation training had higher blood
pressure reactivity to the TSST—although these effects were not statistically significant. Our
periodic 2-minute sampling of blood pressure during the TSST may have failed to reliably
measure blood pressure reactivity, a study limitation. Finally, the use of an audio-guided
mindfulness training program is both strength and limitation of this study. While this approach is
more portable and replicable in different settings (a strength), the absence of a trained
mindfulness instructor for guidance and feedback may diminish the efficacy of the training (a
limitation).
Conclusions
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
22!
The present study offers new insights into how brief mindfulness meditation training and
dispositional mindfulness can impact stress reactivity to acute stress challenge. Compared to an
active cognitive analytic control training, we provide initial evidence that a brief mindfulness
meditation training program (75 minutes) buffers self-reported psychological stress reactivity
and increases cortisol reactivity to the TSST. We postulate that this pattern reflects greater
engagement and active coping in the mindfulness meditation trained group. We also provide
initial evidence for interactive effects of mindfulness meditation training and pre-existing
dispositional mindfulness, showing that either mindfulness training or dispositional mindfulness
can be used as a stress-protective psychological resource. This study is the first well-controlled
test of the mindfulness training stress buffering hypothesis, and expands our understanding of
how mindfulness training interventions impact stress reactivity. It will be important to test
whether these mindfulness-stress pathways affect susceptibility to stress-related disease
outcomes. Given that brief mindfulness meditation training increased cortisol reactivity, one
possibility is that these increases in cortisol may blunt stress-related increases in inflammation
via HPA-axis negative feedback (Barnes et al., 1993; Steptoe et al., 2007), but we note that
longer-term mindfulness meditation training may be needed for clinically meaningful health
benefits in at-risk stressed patient populations.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
23!
Acknowledgments
We thank Fadel Zeidan for sharing his mindfulness meditation scripts, which we adapted for this
study, the research assistants in the Health and Human Performance Laboratory at Carnegie
Mellon University, and Sheldon Cohen for feedback. This research was supported by the
Pittsburgh Life Sciences Greenhouse Opportunity Fund. The authors report no conflicts of
interest.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
24!
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!!!
Table 1a. Mixed effect linear model analysis results for salivary cortisol reactivity to the TSST.
Effect F-value p-value
Time F(3,191) = 2.54 .058
Study Condition F(1,65) = 4.60 .036
Trait Mindfulness F(1,65) = 2.30 .13
Study Condition x Time F(3,191) = 4.80 .003
Study Condition x Trait Mindfulness F(1,65) = 4.38 .040
Trait Mindfulness x Time F(3,191) = 1.16 .33
Table 1b. Mixed effect linear model analysis results for systolic and diastolic blood pressure
reactivity to the TSST.
F-value p-value
Systolic Blood Pressure
Time F(4,254) = 6.91 < .001
Study Condition F(1,65) = 2.50 .12
Trait Mindfulness F(1,65) = .588 .45
Study Condition x Time F(4,254) = .949 .44
Study Condition x Trait Mindfulness F(1,65) = 1.99 .16
Trait Mindfulness x Time F(4,254) = .756 .56
Study Condition x Trait Mindfulness x Time F(4,254) = 1.04 .39
Diastolic Blood Pressure
Time F(4,254) = 4.98 .001
Study Condition F(1,65) = .264 .61
Trait Mindfulness F(1,65) = .000 >.99
Study Condition x Time F(4,254) = .677 .61
Study Condition x Trait Mindfulness F(1,65) = .116 .73
Trait Mindfulness x Time F(4,254) = .477 .75
Study Condition x Trait Mindfulness x Time F(4,254) = .621 .65
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
1!
Figure Captions
Figure 1. An overview of study procedures. Participants completed three consecutive days of
attention training, then completed the TSST after their attention training on day three.
Figure 2. Psychological stress perceptions during the TSST math and speech tasks as a function
of dispositional mindfulness and mindfulness meditation (vs. control) training. To graphically
depict the interaction pattern, low and high dispositional mindfulness groups were defined by a
median split. Error bars reflect +/- 1 standard error.
Figure 3. Salivary cortisol responses during the laboratory session as a function of dispositional
mindfulness and mindfulness meditation (vs. control) training. To graphically depict the
interaction pattern, low and high dispositional mindfulness groups were defined by a median
split. Error bars reflect +/- 1 standard error.
Figure 4. Systolic blood pressure responses during the laboratory session as a function of
dispositional mindfulness and mindfulness meditation (vs. control) training. To graphically
depict the interaction pattern, low and high dispositional mindfulness groups were defined by a
median split. Error bars reflect +/- 1 standard error.
Figure 5. Diastolic blood pressure responses during the laboratory session as a function of
dispositional mindfulness and mindfulness meditation (vs. control) training. To graphically
depict the interaction pattern, low and high dispositional mindfulness groups were defined by a
median split. Error bars reflect +/- 1 standard error.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
2!
Figure 1. An overview of study procedures. Participants completed three consecutive days of
attention training, then completed the TSST after their attention training on day three.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
3!
Figure 2. Psychological stress perceptions during the TSST math and speech tasks as a function
of dispositional mindfulness and mindfulness meditation (vs. control) training. To graphically
depict the interaction pattern, low and high dispositional mindfulness groups were defined by a
median split. Error bars reflect +/- 1 standard error.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
4!
Figure 3. Salivary cortisol responses during the laboratory session as a function of dispositional
mindfulness and mindfulness meditation (vs. control) training. To graphically depict the
interaction pattern, low and high dispositional mindfulness groups were defined by a median
split. Error bars reflect +/- 1 standard error.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
5!
Figure 4. Systolic blood pressure responses during the laboratory session as a function of
dispositional mindfulness and mindfulness meditation (vs. control) training. To graphically
depict the interaction pattern, low and high dispositional mindfulness groups were defined by a
median split. Error bars reflect +/- 1 standard error.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Mindfulness Training and Stress
6!
Figure 5. Diastolic blood pressure responses during the laboratory session as a function of
dispositional mindfulness and mindfulness meditation (vs. control) training. To graphically
depict the interaction pattern, low and high dispositional mindfulness groups were defined by a
median split. Error bars reflect +/- 1 standard error.
