The Impact of Group-Based Mindfulness Training on Self-Reported Mindfulness: a Systematic Review and Meta-analysis

Abstract

Mindfulness-based interventions (MBIs) show promising results in both clinical and non-clinical settings. A number of studies indicate that self-reported mindfulness is associated with adaptive psychological functioning and decreased symptom distress. However, there have been no systematic reviews of research on self-reported mindfulness as an outcome of MBIs for clinical and non-clinical samples. It is also unclear to what extent MBIs actually lead to increased and stable self-reported mindfulness. A systematic literature search was conducted to identify studies measuring self-reported mindfulness before and after an MBI. Meta-analytic procedures were used to investigate self-reported mindfulness as an outcome of MBIs. The results show that several questionnaires have been designed to measure mindfulness, and these have been applied to a variety of samples. Although methodological issues preclude definite conclusions, the meta-analysis indicates that MBIs increase self-reported mindfulness. Effect sizes indicate that increases are in the medium range (Hedges’ g = 0.53). However, over half of the studies found no significant effects of MBIs on self-reported mindfulness from pre- to post-intervention. Also, studies of MBIs against active control conditions show no significant advantage for MBIs in increasing self-reported mindfulness. This raises serious questions concerning the validity of the mindfulness questionnaires currently in use. The addition of a full or half day of intensive mindfulness training (retreats) as part of the intervention moderate the effect sizes in positive direction. Implications for future research include the need for analysis of statistical mediation as well as further validation of questionnaires. Comparisons of MBIs to established evidence-based interventions as active control conditions are also called for.

Full text

ORIGINAL PAPER
The Impact of Group-Based Mindfulness Training
on Self-Reported Mindfulness: a Systematic
Review and Meta-analysis
Endre Visted &Jon Vøllestad &Morten Birkeland Nielsen &
Geir Høstmark Nielsen
#Springer Science+Business Media New York 2014
Abstract Mindfulness-based interventions (MBIs) show
promising results in both clinical and non-clinical settings. A
number of studies indicate that self-reported mindfulness is
associated with adaptive psychological functioning and de-
creased symptom distress. However, there have been no sys-
tematic reviews of research on self-reported mindfulness as an
outcome of MBIs for clinical and non-clinical samples. It is
also unclear to what extent MBIs actually lead to increased
and stable self-reported mindfulness. A systematic literature
search was conducted to identify studies measuring self-
reported mindfulness before and after an MBI. Meta-analytic
procedures were used to investigate self-reported mindfulness
as an outcome of MBIs. The results show that several ques-
tionnaires have been designed to measure mindfulness, and
these have been applied to a variety of samples. Although
methodological issues preclude definite conclusions, the
meta-analysis indicates that MBIs increase self-reported
mindfulness. Effect sizes indicate that increases are in the
medium range (Hedges’g=0.53). However, over half of the
studies found no significant effects of MBIs on self-reported
mindfulness from pre- to post-intervention. Also, studies of
MBIs against active control conditions show no significant
advantage for MBIs in increasing self-reported mindfulness.
This raises serious questions concerning the validity of the
mindfulness questionnaires currently in use. The addition of a
full or half day of intensive mindfulness training (retreats) as
part of the intervention moderate the effect sizes in positive
direction. Implications for future research include the need for
analysis of statistical mediation as well as further validation of
questionnaires. Comparisons of MBIs to established
evidence-based interventions as active control conditions are
also called for.
Keywords Mindfulness .Mindfulness-based .Assessment .
Questionnaire .Group .Intervention
Introduction
Exercises aimed at developing mindfulness skills are increas-
ingly being incorporated into psychological interventions
(Chiesa and Malinowski 2011; Gilpin 2008; Shapiro and
Carlson 2009). The concept of mindfulness is defined as
“the awareness that emerges through paying attention on
purpose, in the present moment, and non-judgmentally to
the unfolding experience moment by moment”(Kabat-Zinn
2003). The first program to include extensive cultivation of
mindfulness was mindfulness-based stress reduction (MBSR;
Kabat-Zinn 1990). Several interventions are now based on the
systematic training of mindfulness skills to alleviate stress and
sufferingassociated with a range of somatic and psychological
disorders. Mindfulness-based interventions (MBIs), including
MBSR, mindfulness-based cognitive therapy (MBCT; Segal
et al. 2002; Teasdale et al. 2000), and mindfulness-based
relapse prevention (MBRP; Bowen et al. 2011), are group-
based interventions that provide an experiential introduction
to mindfulness through various exercises and homework as-
signments aimed at developing mindfulness through formal
practice and in daily life. MBIs are usually carried out through
eight 2–3-hsessionsweeklywithgroupscomprisingupto30
participants. In addition, a whole or half day of intensive
mindfulness training (“silent retreat”) is typically provided
E. Visted (*):G. H. Nielsen
Department of Clinical Psychology, University of Bergen,
Christiesgt. 12, 5015 Bergen, Norway
e-mail: endrevis@gmail.com
J. Vøllestad
Solli District Psychiatric Centre, Bergen, Norway
M. B. Nielsen
National Institute of Occupational Health, Oslo, Norway
Mindfulness
DOI 10.1007/s12671-014-0283-5

during the sixth week (Kabat-Zinn 1990). Although MBIs
may differ somewhat in terms of the specific exercises they
employ, they share a conceptual framework influenced by
Buddhist psychology (Baer and Krietemeyer 2006; Fennell
and Segal 2011). Consequently, they all rest on the assumption
that systematic cultivation of non-judgmental and present-
centered awareness will lead to decreased stress and suffering
(Bishop et al. 2004).
Empirical studies indicate that MBIs are effective for var-
ious somatic and psychological disorders, as reduction in
symptoms and improved well-being are consistently observed
after participation (Keng et al. 2011). To understand how this
impact comes about, it is important to establish that these
interventions actually lead to an increased capacity for mind-
ful awareness. Of relevance to this aim, a number of self-
report questionnaires have been developed to quantify the
construct of mindfulness (Baer 2011). These questionnaires
assess mindfulness either as a trait- or state-like property.
Mindfulness as a trait concerns the general tendency to be
mindful in daily life (Brown and Ryan 2003), whereas state
mindfulness denotes the ability to evoke a mindful mode of
awareness at a given point in time (Lau et al. 2006).
Studies indicate that higher self-reported mindfulness is
associated with aspects of psychological functioning that pro-
mote quality of life and well-being (e.g., Baer et al. 2006)and
decreased distress related to several disorders, including de-
pression (Gilbert and Christopher 2010; Sanders and Lam
2010), anxiety (Arch and Craske 2010; Rasmussen and
Pidgeon 2010), eating disorders (Lavender et al. 2009), and
chronic pain (McCracken and Thompson 2009; Schütze et al.
2010). There is also preliminary evidence that self-reported
mindfulness serves as a statistical mediator of the relationship
between MBIs and a number of outcome variables (Bränström
et al. 2010; Carmody and Baer 2008).
A recent review by Sauer et al. (2013) identified a number of
questionnaires aimed at measuring mindfulness. The review
evaluated the questionnaires in terms of their conceptual frame-
work, empirical support, and usage. However, the review did
not investigate the characteristics of MBI trials assessing self-
reported mindfulness, such as study design, target population,
intervention type, and mindfulness questionnaire used. The
authors also did not examine the possible statistical mediation
of mindfulness on outcome. Consequently, we do not have
systematic knowledge about the particular features of studies
measuring mindfulness before and after a MBI and whether
self-reported mindfulness mediates outcome.
One recent meta-analysis explored whether mindfulness
training may increase self-reported mindfulness (Eberth and
Sedlmeier 2012). The authors found that mindfulness training
had a small effect on self-reported mindfulness. However, in
that study, trials featuring clinical samples, as well as non-
controlled trials, were excluded. In addition, the analysis did
not investigate whether increased self-reported mindfulness
remained stable over time. Consequently, no previous studies
have yet assessed the effect of MBIs on self-reported mind-
fulness in both clinical and non-clinical samples and whether
the effect remains stable at follow-up.
The utilization of mindfulness in psychological interven-
tions has been characterized as a paradigmatically different
approach compared to established evidence-based behavioral
therapies (Hayes 2004). For instance, cognitive behavioral
therapy seeks to change the irrational content of cognition,
whereas the emphasis in MBIs is to alter the quality of
awareness and relationship to personal experience (Segal
et al. 2004). Consequently, one should expect mindfulness
training to lead to increases in self-reported mindfulness,
while this would not be an expected outcome of other inter-
ventions. However, it is not, at present, clear whether in-
creases in self-reported mindfulness can be attributed exclu-
sively to mindfulness training.
We currently do not know which features of trials may
promote increases in self-reported mindfulness. Hence, it is of
interest to investigate whether any characteristics of study
design, participants, or intervention type serves to moderate
self-reported mindfulness. For instance, it is relevant to know
whether non-clinical samples are different from clinical sam-
ples in terms of increased self-reported mindfulness. It is also
of interest to investigate whether different mindfulness ques-
tionnaires are associated with different effect sizes. This may
serve as an indicator of the sensitivity of change of the various
instruments. Finally, MBIs vary in duration and treatment
dosage. It is uncertain whether total intervention time and
number of sessions affect self-reported mindfulness.
In sum, several key questions regarding the measurement
of self-reported mindfulness before and after MBIs are still not
answered. Thus, the primary aims of the present study were to
systematically review controlled and uncontrolled trials of
MBIs measuring pre- and post-intervention self-reported
mindfulness in clinical and non-clinical samples and to eval-
uate their impact on self-reported mindfulness. We further
wanted to answer the following questions:
1. What are the defining features of studies measuring self-
reported mindfulness before and after a MBI?
Specifically, what kinds of study designs, types of partic-
ipant groups, and mindfulness interventions are found?
2. Which self-report questionnaires are currently used to
measure mindfulness in MBI trials?
3. Does mindfulness training lead to increased self-reported
mindfulness? If so, are these changes maintained over
follow-up periods?
4. Do changes in self-reported mindfulness mediate the ef-
fects of interventions?
5. Are increases in self-reported mindfulness exclusively
associated with MBI groups, or are changes also observed
in control groups?
Mindfulness

6. Do particular features of MBI trials and self-report ques-
tionnaires statistically moderate self-reported mindfulness?
Method
Identification of Studies
Eligible studies were identified by searching the databases
MEDLINE, PsycINFO, FRANCIS, and ISI Web of
Knowledge using the term “mindfulness”in combination with
the terms “training”,“meditation”,“program*”,“therapy”,
“intervention”,“questionnaire*”,“factor analysis”,“mea-
sure*”,“psychometric”,“assess*”,“self-report”, and “fac-
et*”. In addition, reference lists from other reviews were
scanned to identify potential eligible studies. All peer-
reviewed articles in languages mastered by the authors
(English, Norwegian, Danish, Swedish, or German) describ-
ing a design using any MBI together with at least one assess-
ment of mindfulness through self-report questionnaire(s) were
included by the first author for further examination. Studies
were finally included in the review if they met the following
inclusion criteria:
1. Intervention was mindfulness-based (with “mindfulness-
based”operationalized as “teaching participants tech-
niques of formal and informal meditation practice as a
fundamental aspect of the intervention”) and conducted in
groups with a minimum length of 4 weeks.
2. Assessment instrument was a self-report questionnaire
designed to measure mindfulness.
3. Study design had a pre-post within- and/or between-group
assessment design and incorporated either randomized
controlled trials or uncontrolled trials.
4. Reported data were sufficient for calculating effect sizes,
including pre- and post-mindfulness scores (M) and stan-
dard deviations/errors (SD), number of participants (N),
pvalues, confidence intervals, and Fvalues.
Studies were excluded if any of the following exclusion
criteria were met:
1. Intervention lacked description to determine if it was root-
ed in mindfulness, featured other forms of meditation than
mindfulness meditation, lacked a well-organized program,
i.e., no clearly delineated structure, schedule of practice, or
formal group setting, or was an intensive retreat.
2. Assessment instrument was not explicitly described as
measuring mindfulness. Studies only incorporating ques-
tionnaires designed to measure theoretically overlapping
constructs such as decentering (The Experience
Questionnaire; Fresco et al. 2007) and self compassion
(The Self Compassion Scale; Neff 2003) were excluded,
because they do not claim to measure mindfulness as such.
3. Study incorporated single case or N= 1 study designs.
The selection process was aided by a screening form de-
signed for the present purpose. The selection process was
validated by the second author using the same screening form.
Studies coded differently by the authors were discussed to
reach consensus. Finally, corresponding authors were
contacted for studies that did not report pre- and post-data. A
study was excluded if authors did not respond and/or the data
reported was insufficient to calculate effect sizes.
For articles reporting a full- or half-day retreat without
reporting the precise duration, an estimated duration of 390
or 195 min, respectively, was added to the total intervention
time as default. In cases where no retreat was reported, it was
assumed that none was offered. For articles reporting a time
interval for session time, the mean value of the interval was
coded (e.g., 120–140 min=130 min). Standard errors (SEs)
were converted to SDs using the following formula: SD=
SE√(n) (Thalheimer and Cook 2002). Further, only the last
follow-up assessment was included when several follow-up
measures were reported. Computation of descriptive and fre-
quency data were carried out in the software SPSS Version 19
for Windows.
Estimation of Effect Sizes
Several options to calculate effect sizes are available
(Borenstein et al. 2009;Schulze2004). It was expected that
many studies would have small sample sizes. Hedges’gwas
therefore considered the best choice, being a variation of
Cohen’sdthat corrects for biases due to small sample sizes
(Hedges and Olkin 1985).
Hedges’gwithin-group effect sizes for self-reported mind-
fulness were calculated for all studies, given sufficient avail-
able data. These estimates were then combined to obtain a
summary statistic across all studies.
For randomized controlled trials, Hedges’gfor differences
in treatment effects between MBIs and control conditions
were calculated. Studies including “treatment as usual”as
control conditions were classified as active control conditions.
Some studies included several mindfulness measures or
applied multidimensional measurements. In these cases, effect
sizes for each measure or dimension were calculated first,
followed by calculation of the average Hedges’geffect size
for each study. When subscales and total scale scores were
reported, the total scale scores were excluded from the analy-
ses to avoid confounding effect sizes.
The random effects model was used when calculating the
pooled mean effect sizes. This allows for statistical inferences
to a population of studies beyond those included in the meta-
analysis. The interpretation of effect sizes was aided by Cohen
Mindfulness

(1988) guidelines: a value of 0.2 represents a small effect, 0.5
a medium effect, and 0.8 a large effect.
Moderator Analysis
The Q statistic was used to assess the heterogeneity of included
studies. A significant Qvalue rejects the null hypothesis of
homogeneity. The I
2
statistic was computed as an indicator of
heterogeneity in percentages. The I
2
describes the percentage of
total variation across studies that are due to heterogeneity rather
than chance. The interpretation of the percentage was aided by
Higgins and co-authors’guidelines, with values of 0 % indicat-
ing no heterogeneity, 50 % indicating moderate heterogeneity,
and 75 % indicating high heterogeneity (Higgins et al. 2003).
To investigate potential moderator effects, a procedure
proposed by Hedges and Olkin (1985) was used.
According to that approach, meta-analytic evidence for
thepresenceofmoderatorsrequiresthateffectsizeesti-
mates are statistically different in the categories formed by
the potential moderator variable (Borenstein et al. 2009).
The degree of variability of the effect size estimates across
studies is measured by separating studies according to
potential moderators and then conducting a pooling of
effect sizes separately for each subgroup. In order to assess
the presence of a significant difference between groups, the
between-group heterogeneity statistic Q
B
was computed. A
statistically significant Q
B
indicates a moderator effect,
suggesting a difference between mean effect sizes for the
different groups.
Meta-regression analyses with total duration of interven-
tion as the moderator variable was conducted to examine
whether there was a dose-response relationship between inter-
vention duration and the effects of MBIs on outcomes as well
as between number of sessions and the established effect sizes.
As it is not possible to combine several outcome measures
from the same study in meta-regression analyses, the dose-
response analyses were conducted separately for each mind-
fulness questionnaire.
Finally, a subgroup moderator analysis was conducted in
order to determine whether effect sizes were dependent on the
utilized mindfulness questionnaires.
Publication Bias
The present paper included only published studies.
Evidence shows that studies that report relatively high
effect sizes are more likely to be published than studies
that report lower effect sizes, an issue known as “file-
drawer problem”or publication bias (Borenstein et al.
2009). Two approaches were applied to control for publi-
cation bias. First, the fail-safe Nwas calculated,
representing the required number of studies reporting null
results to reduce the overall effect size to non-significant.
Second, a funnel plot was visually inspected for asymme-
try to assess potential biases in the distribution of effects.
A funnel plot is a scatter plot of the effect sizes from
individual studies (horizontal axis) against a measure of
study size (vertical axis). In the absence of bias, studies
with large sample sizes should be placed toward the top
and smaller studies will scatter more widely at the bottom
of the plot (Sterne et al. 2011).
Effect size calculations, meta-analysis, and publica-
tion bias analysis were carried out with the software
Comprehensive Meta Analysis version 2 (Borenstein
et al. 2011).
Results
Eligible Studies
The search was conducted through March 4th 2011 and
yielded 1,425 results. Eighty-seven studies were included
for the second screening; 1,338 studies were excluded (n=
633 not reaching inclusion criteria; n=705 duplicates).
After closer inspection of identified studies, 16 studies were
excluded (n=1 based on same data as another eligible
study; n=2 being protocol descriptions; n=9 due to the
nature of intervention; and n=4 due to type of mindfulness
questionnaire). Sixteen authors were contacted requesting
missing data necessary to compute effect sizes from 18
trials. Eight authors provided necessary data; six studies
were included using available statistical data, and three
studies not providing necessary data were excluded. Four
studies were included after reviewing reference lists of
previous reviews and other relevant literature. In sum, a
total of 72 studies were found eligible for inclusion. All
included studies were in the English language. See Fig. 1
for flow chart and “Appendix A”for overview and sum-
mary of all included studies.
Characteristics of Studies
The first study to be published appeared in 2005 (Cohen-Katz
et al. 2005). Most studies were published after 2008
(n=61, 85 %). The majority of studies were uncontrolled or
open trials (n=46, 64 %). Twenty-six studies (36 %) were
randomized controlled trials (RCT), including waiting-list
(WLC; n=13), active (AC; n= 6), and treatment as usual
(TAU; n= 3) control conditions. In addition, four studies ap-
plied a three-arm control design including experimental, ac-
tive, and waiting-list control conditions (Oken et al. 2010;
Ortner et al. 2007; Schmidt et al. 2010; Shapiro et al. 2008).
Twenty-three (32 %) studies included follow-up mea-
surements on average 4.56 months after intervention
end (range 1–15).
Mindfulness

Characteristics of Participants
The aggregated number of participants receiving a MBI was
2,901. Subjects’mean age was 45 years, with a range from
14.4 to 78 (SD=12.1). Aggregated dropout rate was 18 % and
completion rate 82 %. Study sample size ranged from 10 to
320 participants (M=40.2, SD=44.6).
The majority (n=47, 65 %) of the trials consisted of clinical
samples, including somatic disorders (n=17), heterogeneous
disorders (samples consisting of participants with more than
one diagnosis; n=9), affective disorders (n=5), substance
abuse disorders (n=5), anxiety disorders (n=4), and sleep
disorders (n=2). Further, single studies consisted of samples
with personality disorders (Sachse et al. 2010), psychotic
disorders (Chadwick et al. 2009), externalizing problems
(conduct disorders, attention deficit hyperactivity disorder,
and oppositional defiant disorder; Bögels et al. 2008), post-
traumatic stress disorder (Kimbrough et al. 2010), and general
distress (Nyklíček and Kuijpers 2008). Twenty-five studies
(35 %) had non-clinical samples.
Characteristics of Interventions
MBSR was the most frequent intervention (n= 29, 40 %),
followed by sample-specific interventions (n= 27, 38 %) and
MBCT (n=16, 22 %). The mean number of facilitators per
group was 1.5 (SD =0.7), ranging from 1 to 4 (mode=1). Only
two studies assessed therapists’competence and adherence to
treatment manuals (Altmaier and Maloney 2007;Baumetal.
2010). Total number of sessions ranged from 4 to 18, with a
mode of 8 sessions. Session length ranged from 20 to 180 min,
with a mean of 125 min (SD=34.2). The mean total interven-
tion length, retreat time included, was 1,132.5 min (18.86 h;
SD= 521.9), ranging from 120 to 3,120 min (2–52 h). These
sessions were given within an average of 8 weeks (SD=1.8),
ranging from 4 to 18 weeks.
Although most studies (n=46, 64 %) did not report whether
or not their intervention included a full- or half-day retreat, 21
studies (29 %) reported having a full-day retreat, 2 studies
(3 %) half-day retreat, and 3 studies (4 %) explicitly reporting
having no retreat.
Active control conditions included progressive muscle re-
laxation (Agee et al. 2009; Dalen et al. 2010; Schmidt et al.
2010), antidepressant treatment (Baum et al. 2010;Brown
et al. 2011), individual psychotherapy (Brown et al. 2011),
12-step abstinence program for alcohol dependence (Bowen
et al. 2009), cognitive group therapy (Brewer et al. 2009),
guided visual imagery (Kingston et al. 2007), health education
program (Morone et al. 2009), education classes for dementia
caregivers (Oken et al. 2010), other meditation programs
N = 1425 studies extracted
from electronic database
search
n = 87 selected for second
screening
n = 4 included from reference
lists
n = 705 duplicates removed
n = 633 excluded not meeting
inclusion criteria
n = 72 eligible studies
included in review
n = 16 excluded not meeting
inclusion criteria
n = 3 excluded not providing
necessary data for
computation of effect sizes
Fig. 1 Study flow diagram
Mindfulness

(Ortner et al. 2007; Shapiro et al. 2008), and support groups
for alcohol dependence (Garland et al. 2010) and obstructive
lung disease (Mularski et al. 2009).
Mindfulness Questionnaires
Ten independent self-report questionnaires were applied 84
times in the included studies, presented in Table 1.
The Mindful Attention Awareness Scale (MAAS;
Brown and Ryan 2003) rates frequency of experience
associated with lapses of inattentiveness. The instrument
was constructed on the theoretical assumption that the
respondent’s degree of attention to, and awareness of,
what is occurring in the present moment is the main
variable in mindfulness.
The Five Facet Mindfulness Questionnaire (FFMQ; Baer
et al. 2006) includes statements measuring mindfulness skills.
Factor-analytic procedures were carried out on an item-pool
consisting of items from five published and unpublished
mindfulness questionnaires.
The Kentucky Inventory of Mindfulness Skills (KIMS; Baer
et al. 2004) is the precursor to the FFMQ and shares attributes
of the FFMQ in respect to number of items and rating scales.
The item construction was based on four mindfulness
modules applied in dialectical behavior therapy (Baer
et al. 2004;Baumetal.2010; Linehan and Dexter-
Mazza 2008).
The Toronto Mindfulness Scale (TMS; Lau et al. 2006)
assesses immediate respondent mindfulness experience. Two
different versions of the TMS were found to be applied in
studies included in the current review; an unpublished 10-item
one-factor version (N= 5) and a published two-factor 13-item
version (N=2). The TMS assesses the capacity to invoke a
state of mindfulness, and not the general tendency to be
mindful in daily life like other questionnaires. The question-
naire is therefore typically administered after a session
of meditation.
The Freiburg Mindfulness Inventory (FMI; Buchheld et al.
2001; Walach et al. 2006a,b) rates the frequency of experi-
ences associated with mindfulness. Two versions of the
FMI are available: A 14-item version recommended for
meditation-naïve participants (Walach et al. 2006a, Walach
et al. 2006b), and a 30-item version recommended for research
purposes (Buchheld et al. 2001). One study used the 30-item
version and five applied the short version.
Other Mindfulness Questionnaires
The following questionnaires were applied once in the includ-
ed studies. The Cognitive and Affective Mindfulness Scale
Revised (CAMS-R; Feldman et al. 2007) rates the respon-
dents’degree of mindfulness related to thoughts and feelings.
The Southampton Mindfulness Questionnaire (SMQ;
Chadwick et al. 2008) rates the participants’mindful aware-
ness to distressing thoughts and images. Three mindfulness
questionnaires were modified versions of questionnaires de-
scribed above, including The Southampton Mindfulness of
Voices Questionnaire (SMVQ; Chadwick et al. 2007), The
Mindful Attention Awareness Scale-Adolescent (MAAS-A;
Ta b l e 1 Overview of questionnaires designed to measure mindfulness
applied in included studies, summarizing practical and theoretical
differences
Measurement nItems Components Key concepts
MAAS 34 15 One Attention and awareness
FFMQ 18 39 Five Observing
Describing
Acting with awareness
Accepting without
judgment
Non-reactivity
KIMS 14 39 Four Observing
Describing
Acting with awareness
Accepting without
judgment
TMS 7 13 and 10 Two and one Awareness
Attitudes of curiosity
and acceptance
Decentering
FMI 6 30 and 14 One Present-moment
disidentifying attention
MAAS-A 1 14 One Same as MAAS
CAMS-R 1 12 One Attention
Present focus
Awareness
Acceptance
SMQ 1 16 One Decentered vs. reactive
awareness
Attention to vs. avoidance
of difficult
cognition
Acceptance of vs.
judgment of difficult
cognition and self
Letting go of vs. worrying
about cognition
SMVQ 1 12 One Same as SMQ
KIMS-E 1 46 Five Same as FFMQ
FMI Freiburg Mindfulness Inventory, MAAS Mindful Attention Aware-
ness Scale, MAAS-A Mindful Attention Awareness Scale Adolescent,
TMS Toronto Mindfulness Scale, KIMS Kentucky Inventory of Mindful-
ness Skills, CAMS-R Cognitive and Affective Mindfulness Scale Revised,
SMQ Southampton Mindfulness Questionnaire, SMVQ Southampton
Mindfulness of Voices Questionnaire, FFMQ Five Facet Mindfulness
Questionnaire, KIMS-E Kentucky Inventory of Mindfulness Skills
Extended
Mindfulness

Brown et al. 2011), and The Kentucky Inventory of
Mindfulness Skills-Extended (KIMS-E; Raes et al. 2009).
Mediation Analyses
Eleven studies (16 %) investigated whether self-reported
mindfulness mediated outcomes on other variables. Most
studies found evidence of mediation in the expected
direction. Results from mediator analyses are presented
in Table 2.
Meta-Analysis
Within-group effect sizes for self-reported mindfulness
were computed for all studies reporting sufficient data
(N=71 studies, including 72 trials). Post to follow-up
effect sizes were calculated for 20 trials. For between-
group analyses, effect sizes were calculated and pooled
separately for waiting-list (n=16) and active control
conditions (n=12).
Within-Group Effect Sizes Within-group effect sizes for mind-
fulness scores for individual studies are displayed in Fig. 2.
Pre- to post-treatment effect sizes for self-reported
mindfulness ranged from −0.44 to 1.91. The overall
within-group Hedges’gfor self-reported mindfulness
at post-treatment was 0.53 (p<.001, 95 % confidence
interval (CI)=0.46–0.61). This effect size is in the me-
dium range, indicating that at post-treatment, partici-
pants in MBIs averaged 0.53 standard deviations above
their pre-intervention scores on self-reported mindful-
ness. Heterogeneity was low to moderate (Q= 116.31,
p=.001, I
2
=38.96). From pre- to post-intervention, 37
of 72 trials found no significant effect of MBIs on self-
reported mindfulness.
Effect sizes indicated no significant change in self-
reported mindfulness from post-treatment to follow-up
(Hedges’g=−0.03, p= .61, 95 % CI=−0.15–0.09). These
findings of no change from post-treatment to follow-up
indicate that the degree of self-reported mindfulness was
maintained over time.
Ta b l e 2 Overview of studies in-
vestigating mediation of mindful-
ness on other variables
FFMQ Five Facet Mindfulness
Questionnaire, KIMS Kentucky
Inventory of Mindfulness Skills,
MAAS Mindful Attention Aware-
ness Scale, KIMS-E Kentucky
Inventory of Mindfulness Skills
Extended
a
Mindfulness mediates decrease
b
Mindfulness mediates increase
c
No mediation
Author (year) Mediating variable Clinical outcome
Bränström et al. (2010) FFMQ Perceived stress
a
Avoidance of trauma-related
symptoms
a
Positive states of mind
b
Carmody and Baer (2008) FFMQ Psychological symptoms
a
Perceived stress
a
Psychological well-being
b
Carmody et al. (2009) FFMQ Perceived stress
a
Kingston et al. (2007) KIMS Perceived pain intensity
c
Pain tolerance
c
Blood pressure
c
Kocovski et al. (2009)KIMS
(subscale “accept without judgment”)
Social phobia
a
Labelle et al. (2010) MAAS Depressive symptoms
c
Nyklíček and Kuijpers (2008) MAAS Perceived stress
a
Vital exhaustion (partially)
a
Quality of life
b
Raes et al. (2009) KIMS-E Cognitive reactivity
a
Shahar et al. (2010) MAAS Depressive symptoms
a
Shapiro et al. (2007) MAAS Rumination
a
Trait anxiety
a
Perceived stress
a
Self compassion
b
Shapiro et al. (2008) MAAS Perceived stress
a
Rumination
a
Vøllestad et al. (2011)FFMQ Anxietysymptoms
a
Worry (partially)
a
Trait anxiety (partially)
a
Mindfulness

Study name Outcome Statistics for each study Hedges' g and 95% CI
Hedges'
g
Standard
error
Lower
limit
Upper
limitVariance Z-Value p-Value
Agee et al. (2009) MAAS 0.446 0.330 0.109 -0.201 1.093 1.351 0.177
Altmaier & Maloney (2007) TMS-10 1.913 0.481 0.232 0.970 2.856 3.975 0.000
Anderson et al. (2007) TMS-10 1.598 0.258 0.067 1.092 2.104 6.191 0.000
Baum et al. (2010) Combined 0.460 0.198 0.039 0.073 0.847 2.328 0.020
Birnie et al. (2010) MAAS 0.195 0.419 0.176 -0.626 1.017 0.467 0.641
Bowen et al. (2009) FFMQ-Act 0.137 0.173 0.030 -0.201 0.476 0.794 0.427
Brewer et al. (2009) FFMQ-Tot 0.937 0.475 0.226 0.005 1.869 1.971 0.049
Brown et al. (2011) MAAS-A 0.335 0.143 0.021 0.054 0.616 2.338 0.019
Bränström et al. (2010) Combined 0.571 0.285 0.081 0.012 1.130 2.001 0.045
Bögels et al. (2008) MAAS 0.176 0.368 0.135 -0.544 0.897 0.480 0.631
Carmody & Baer (2008) Combined 0.656 0.110 0.012 0.440 0.872 5.957 0.000
Carmody et al. (2006) TMS-10 0.620 0.404 0.163 -0.172 1.413 1.535 0.125
Carmody et al. (2008) Combined 0.891 0.224 0.050 0.452 1.330 3.978 0.000
Carmody et al. (2009) Combined 0.820 0.084 0.007 0.656 0.985 9.775 0.000
Cohen-Katz et al. (2005) MAAS 0.868 0.322 0.103 0.237 1.498 2.697 0.007
Collard et al. (2008) FMI-14 0.493 0.361 0.130 -0.215 1.200 1.366 0.172
Cusens et al. (2010) MAAS 1.116 0.426 0.181 0.281 1.950 2.621 0.009
Dalen et al. (2010) Combined 0.631 0.440 0.194 -0.232 1.495 1.434 0.152
Deyo et al. (2009) Combined 0.622 0.312 0.097 0.010 1.234 1.993 0.046
Dobkin (2008) MAAS 0.543 0.387 0.150 -0.216 1.302 1.401 0.161
Duncan & Bardacke (2010) Combined 0.554 0.290 0.084 -0.015 1.123 1.909 0.056
Eisendrath et al. (2008) FMI-30 0.531 0.289 0.084 -0.036 1.098 1.837 0.066
Evans et al. (2008) MAAS 0.805 0.428 0.183 -0.033 1.644 1.882 0.060
Evans et al. (2010) MAAS 1.253 0.403 0.163 0.462 2.043 3.106 0.002
Foley et al. (2010) FMI-14 0.667 0.196 0.039 0.282 1.052 3.393 0.001
Frewen et al. (2008) Combined 1.019 0.268 0.072 0.495 1.544 3.806 0.000
Garland et al. (2010) FFMQ-Tot 0.108 0.335 0.112 -0.548 0.765 0.324 0.746
Gross et al. (2010) MAAS 0.339 0.201 0.041 -0.056 0.734 1.682 0.092
Gökhan et al. (2010) Combined 0.521 0.302 0.091 -0.071 1.112 1.726 0.084
Huppert & Johnson (2010) CAMS-R 0.172 0.160 0.025 -0.141 0.485 1.077 0.281
Hölzel et al. (2011) Combined 0.661 0.379 0.144 -0.082 1.403 1.744 0.081
Kaufman et al. (2009a) Combined 0.549 0.361 0.131 -0.159 1.257 1.519 0.129
Kaufman et al. (2009b) Combined -0.046 0.263 0.069 -0.562 0.470 -0.174 0.862
Kimbrough et al. (2010) MAAS 0.980 0.296 0.088 0.400 1.560 3.312 0.001
Kingston et al. (2007) KIMS 0.748 0.314 0.098 0.134 1.363 2.387 0.017
Klatt et al. (2009) MAAS 0.479 0.300 0.090 -0.110 1.068 1.596 0.111
Kocovski et al. (2009) Combined 0.491 0.263 0.069 -0.025 1.008 1.864 0.062
Krasner et al. (2009) Combined 0.776 0.183 0.034 0.417 1.136 4.231 0.000
Labelle et al. (2010) MAAS 0.478 0.210 0.044 0.067 0.889 2.280 0.023
Lau et al. (2006) Combined 0.505 0.144 0.021 0.223 0.788 3.512 0.000
Lovas & Barsky (2010) FFMQ-Tot 0.710 0.443 0.196 -0.158 1.578 1.604 0.109
Matchim et al. (2010) FFMQ-Tot 0.722 0.367 0.135 0.002 1.441 1.964 0.049
Matousek & Dobkin (2010) MAAS 0.580 0.190 0.036 0.208 0.953 3.054 0.002
Michalak et al. (2008) MAAS 0.646 0.286 0.082 0.086 1.206 2.259 0.024
Morone et al. (2009) Combined 0.110 0.345 0.119 -0.566 0.787 0.320 0.749
Mularski et al. (2009) FFMQ-Tot -0.444 0.226 0.051 -0.887 -0.002 -1.968 0.049
Nyklícek & Kuijpers (2008) Combined 0.407 0.262 0.069 -0.107 0.921 1.551 0.121
Oken et al. (2010) Combined 0.237 0.476 0.226 -0.695 1.169 0.499 0.618
Ong et al. (2008) KIMS-Tot 0.132 0.255 0.065 -0.368 0.633 0.519 0.604
Ong et al. (2009) Combined 0.176 0.304 0.092 -0.419 0.771 0.581 0.561
Ortner et al. (2007) Combined 0.618 0.313 0.098 0.005 1.230 1.975 0.048
Pradhan et al. (2007) MAAS 0.011 0.264 0.069 -0.505 0.528 0.043 0.966
Raes et al. (2009) KIMS-E 0.781 0.339 0.115 0.117 1.444 2.305 0.021
Ree & Craigie (2007) MAAS 0.311 0.292 0.085 -0.260 0.883 1.067 0.286
Rimes & Wingrove (2011) FFMQ-Tot 0.607 0.317 0.101 -0.015 1.229 1.913 0.056
Sachse et al. (2010) FFMQ-Tot 0.193 0.297 0.088 -0.389 0.774 0.649 0.516
Schmidt et al. (2010) FMI-14 0.501 0.196 0.038 0.117 0.885 2.556 0.011
Schroevers & Brandsma (2010) Combined 0.563 0.179 0.032 0.212 0.914 3.141 0.002
Shahar et al. (2010) MAAS 0.433 0.276 0.076 -0.109 0.975 1.566 0.117
Shapiro et al. (2007) MAAS 0.366 0.299 0.089 -0.219 0.951 1.225 0.220
Shapiro et al. (2008) MAAS 0.536 0.362 0.131 -0.173 1.246 1.482 0.138
Shapiro et al. (2011) MAAS 0.535 0.362 0.131 -0.175 1.244 1.478 0.140
Sharplin et al. (2010) FMI-14 0.662 0.257 0.066 0.158 1.167 2.573 0.010
Smith et al. (2006) MAAS 0.647 0.286 0.082 0.087 1.207 2.264 0.024
Smith et al. (2008) MAAS 0.489 0.237 0.056 0.025 0.953 2.065 0.039
Splevins et al. (2009) Combined 0.440 0.300 0.090 -0.149 1.028 1.465 0.143
Vieten & Astin (2008) MAAS 0.245 0.381 0.145 -0.502 0.992 0.642 0.521
Vieten et al. (2010) FFMQ-Tot 0.670 0.312 0.097 0.059 1.281 2.150 0.032
Vøllestad et al. (2011) FFMQ-Tot 0.648 0.257 0.066 0.143 1.152 2.516 0.012
Weber et al. (2010) Combined 0.079 0.356 0.127 -0.618 0.776 0.222 0.824
Witek-Janusek et al. (2008) MAAS 0.742 0.235 0.055 0.282 1.203 3.160 0.002
Zgierska et al. (2008) MAAS 1.095 0.382 0.146 0.345 1.844 2.863 0.004
0.533 0.040 0.002 0.455 0.612 13.349 0.000
-1.00 -0.50 0.00 0.50 1.00
Decreased mindfulness Increased mindfulness
Mindfulness

Between-Group Effect Sizes for Controlled Studies Effect
sizes computed for controlled trials with a waiting-list com-
parison condition yielded an overall Hedges’gof 0.47
(p<.001, 95 % CI= 0.23–0.7). This estimate indicates that
participants in MBI groups improve their self-reported mind-
fulness scores about half a standard deviation more than
participants receiving no intervention. Heterogeneity was
moderate to high (Q=42, p<.001, I
2
=64.3). Seven studies
found a significant effect of MBIs on self-reported mindful-
ness, while nine studies did not. Effect sizes for studies with
waiting-list control conditions are displayed in Fig. 3.
Effect sizes computed with active control group data indi-
cated that there was no difference between MBIs and active
control conditions in terms of self-reported mindfulness at
post-treatment (Hedges’g=0.09, p= .28, 95 % CI=−0.08–
0.26). Only one study out of 12 favored the MBI condition
(Baum et al. 2010). These results indicate that MBIs do not
lead to greater increases in self-reported mindfulness com-
pared to active control conditions. The effect sizes for studies
with active control conditions are displayed in Fig. 4.
Moderator Analyses
All moderator analyses were performed using within-group data.
Study Design No significant difference was observed when
comparing effect sizes between randomized controlled trials
(Hedges’g=0.45, 95 % CI=0.29–0.6) and uncontrolled trials
(Hedges’g=0.59, 95 % CI= 0.51–0.67; Q
B
=2.5,df=1,p=.11).
Sample Characteristics No significant differences in mean
effect sizes for self-reported mindfulness was found when
comparing clinical (Hedges’g=0.5, 95 % CI=0.41–0.6) to
non-clinical samples (Hedges’g=0.61, 95 % CI=0.46–0.76;
Q
B
=1.47, df =1, p=.23).
Retreats A significant difference in effect sizes was found
between MBIs including retreats (Hedges’g=0.66, 95 %
CI=0.57–0.74) and MBIs excluding retreats (Hedges’
g=0.49, 95 % CI=0.38–0.6; Q
B
=5.76, df =1, p=.02). This
indicates that participants in MBIs including a retreat reported
larger gains in self-reported mindfulness compared to partic-
ipants in MBIs not including a retreat.
Intervention Duration Due to the limited number of studies
that used some of the inventories, dose-response analyses
were only conducted for the MAAS, FFMQ, and KIMS
inventories. The findings from the meta-regression analyses
provided no evidence for a dose-response relationship be-
tween duration and the effect sizes for neither the MAAS
(β=0.00; Q=.11; df=1; p=.74), the FFMQ (β=0.00;
Fig. 2 Within-group effect sizes and pre- to post-treatment change in
mindfulness. MAAS the Mindful Attention Awareness Scale, TMS-10 the
Toronto Mindfulness Scale 10-item version, Combined mean effect size
from several (sub)scales, FFMQ-Act the Five Factor Mindfulness
Questionnaire act with awareness subscale, FFMQ-Tot the Five Factor
Mindfulness Questionnaire total score, MAAS-A the Mindful Attention
Awareness Scale-Adolescent, FMI-14 the Freiburg Mindfulness
Inventory 14-item version. FMI-30 the Freiburg Mindfulness Inventory
30-item version, CAMS-R Cognitive and Affective Mindfulness Scale
Revised, KIMS-E Kentucky Inventory of Mindfulness Skills Extended
Study name Statistics for each study Hedges' g and 95% CI
Hedges' Standard Lower Upper
g error Variance limit limit Z-Value p-Value
Anderson et al. (2007) TMS-10 1.140 0.253 0.064 0.645 1.635 4.516 0.000
Bränström et al. (2010) Combined 0.626 0.265 0.070 0.106 1.146 2.358 0.018
Chadwick et al. (2009) Combined 0.641 0.463 0.214 -0.266 1.548 1.386 0.166
Cohen-Katz et al. (2005) MAAS 1.349 0.432 0.186 0.503 2.195 3.126 0.002
Foley et al. (2010) MAAS 0.676 0.197 0.039 0.289 1.063 3.425 0.001
Gross et al. (2010) MAAS 0.228 0.235 0.055 -0.233 0.690 0.970 0.332
Klatt et al. (2009) MAAS -0.262 0.304 0.093 -0.859 0.335 -0.860 0.390
Nyklicek & Kuijpers (2008) Combined 0.327 0.261 0.068 -0.185 0.838 1.251 0.211
Oken et al. (2010) Combined 0.129 0.466 0.217 -0.785 1.042 0.276 0.782
Ortner et al. (2007) Combined 0.241 0.296 0.087 -0.339 0.820 0.814 0.416
Pradhan et al. (2007) MAAS -0.592 0.261 0.068 -1.104 -0.081 -2.268 0.023
Schmidt et al. (2010) FMI-14 0.616 0.192 0.037 0.238 0.993 3.199 0.001
Shahar et al. (2010) MAAS 0.917 0.312 0.097 0.306 1.528 2.940 0.003
Shapiro et al. (2011) MAAS 0.501 0.361 0.130 -0.207 1.209 1.388 0.165
Vieten & Astin (2008) MAAS 0.255 0.356 0.127 -0.442 0.953 0.717 0.473
Vøllestad et al. (2011) FFMQ-Tot 0.775 0.255 0.065 0.276 1.274 3.042 0.002
0.466 0.120 0.014 0.231 0.702 3.880 0.000
-1.00 -0.50 0.00 0.50 1.00
Favours control Favours MBI
Fig. 3 Effect sizes for controlled studies with waiting-list control condi-
tions. TMS-10 the Toronto Mindfulness Scale 10-item version, Combined
mean effect size from several (sub)scales, MAAS the Mindful Attention
Awar e n es s S c a le, FMI-14 the Freiburg Mindfulness Inventory 14-item
version, FFMQ-Tot the Five Factor Mindfulness Questionnaire total score
Mindfulness

Q=3.16; df=1; p=.07), nor the KIMS (β=0.00; Q=.58;
df=1; p=.45). Similarly, no dose-response relationships were
found between number of sessions and effect sizes for the
MAAS (β=0.03; Q=.36; df=1; p=.55), FFMQ (β=0.01;
Q=.82; df=1; p=.36), or KIMS (β= 0.07; Q=3.62; df =1;p= .06).
Mindfulness Questionnaires The subgroup analyses showed
significant differences between the questionnaires (Q=10.46;
df=4; p<.05). Yet, as displayed in Table 3, the confidence
intervals indicate that the only actual difference is between
TMS and KIMS. It can therefore be concluded that the
use of different measurement instruments has little im-
pact on effect sizes.
Publication Bias
The effect sizes obtained for measures of self-reported
mindfulness corresponded to a zvalue of 17.37. It
would require 5,582 studies with null results to bring
the two-tailed pvalue to exceed .05. This fail-safe N
estimate indicates that the effect sizes observed in the
present meta-analysis are likely to be robust. In addi-
tion, inspection of the funnel plot for precision did not
indicate presence of systematic biases in publishing
(Fig. 5). In sum, these analyses indicate that effect size
estimates of the within-group analyses are unbiased.
Discussion
The general aim of the present study was to systematically
review controlled and uncontrolled trials of MBIs measur-
ing pre- and post-intervention self-reported mindfulness in
clinical and non-clinical samples and to evaluate their effi-
cacy on self-reported mindfulness. Seventy-two studies
were systematically selected from a total of 1,425 studies.
Our systematic search showed that the majority of MBIs
has been studied using uncontrolled designs on a variety of
clinical and non-clinical samples. Most interventions
followed the MBSR protocol, confirming previous findings
that MBSR is the most frequently applied MBI (Baer 2003;
Hofmann et al. 2010). An interesting finding was the
relatively high number of adapted MBIs, that is, interven-
tions based on MBSR or MBCT protocols modified to suit
a particular population. These interventions typically dif-
fered in respect to number of sessions, ranging from 4
(Huppert and Johnson 2010; Kaufman et al. 2009)to18
sessions (Krasner et al. 2009) and in session length, rang-
ing from 40 min (Huppert and Johnson 2010) to 180 min
(Duncan and Bardacke 2010; Kaufman et al. 2009).
Study name Outcome Statistics for each study Hedges' g and 95% CI
Hedges' Standard Lower Upper
g error Variance limit limit Z-Value p-Value
Agee et al. (2009) MAAS -0.223 0.307 0.094 -0.824 0.379 -0.726 0.468
Baum et al. (2010) Combined 0.453 0.198 0.039 0.066 0.841 2.295 0.022
Bowen et al. (2009) FFMQ-Act 0.084 0.206 0.043 -0.320 0.488 0.407 0.684
Brewer et al. (2009) FFMQ-Tot 0.568 0.533 0.284 -0.477 1.613 1.066 0.287
Garland et al. (2010) FFMQ-Tot -0.506 0.332 0.110 -1.156 0.145 -1.524 0.127
Kingston et al. (2007) KIMS 0.091 0.303 0.092 -0.503 0.685 0.300 0.764
Morone et al. (2009) Combined -0.312 0.334 0.112 -0.967 0.343 -0.933 0.351
Mularski et al. (2009) FFMQ-Tot 0.041 0.286 0.082 -0.520 0.601 0.143 0.886
Oken et al. (2010) Combined -0.101 0.444 0.197 -0.971 0.770 -0.227 0.820
Ortner et al. (2007) Combined -0.073 0.297 0.088 -0.654 0.508 -0.246 0.806
Schmidt et al. (2010) FMI-14 0.346 0.192 0.037 -0.030 0.721 1.803 0.071
Shapiro et al. (2008) MAAS 0.088 0.361 0.131 -0.620 0.796 0.243 0.808
0.103 0.080 0.006 -0.054 0.260 1.288 0.198
-1.00 -0.50 0.00 0.50 1.00
Favours control Favours MBI
Fig. 4 Effect sizes for controlled studies including active control condi-
tions. MAAS Mindful Attention Awareness Scale; Combined mean effect
size from several (sub)scales; FFMQ-Act Five Factor Mindfulness Ques-
tionnaire, act with awareness subscale; FFMQ-Tot Five Factor
Mindfulness Questionnaire, total score; KIMS Kentucky Inventory of
Mindfulness Skills; FMI-14 the Freiburg Mindfulness Inventory 14-item
version
Ta b l e 3 Differences in effect sizes between mindfulness questionnaires
Questionnaire K Hedges’g95 % CI
FFMQ 41 .57 .46–.68
FMI 5 .57 .34–.80
KIMS 50 .44 .35–.53
MAAS 35 .55 .46–.64
TMS 7 1.00 .61–1.40
Overall 138 .53 .47–.58
FFMQ Five Facet Mindfulness Questionnaire, FMI Freiburg Mindful-
ness Questionnaire, KIMS Kentucky Inventory of Mindfulness Skills,
MAAS Mindful Attention Awareness scale, TMS Toronto Mindfulness
Scale
Mindfulness

The results indicate that the measurement of self-reported
mindfulness is a recent and growing trend. Ten different self-
report questionnaires were identified. The main difference
between the questionnaires was the number of dimen-
sions or facets seen to comprise mindfulness, ranging
from one (Brown and Ryan 2003; Buchheld et al. 2001)
to five (Baer et al. 2006). In addition, one questionnaire
assessing mindfulness as a state was employed in a
number of studies (Lau et al. 2006). This indicates that
a consensual definition of mindfulness has not been
reached, as has also been pointed out by other authors
(Garland and Gaylord 2009;GrossmanandVanDam
2011; Rapgay and Bystrisky 2009). It also confirms the
complexity of mindfulness and the challenges inherent
in attempts to operationalize it.
The MAAS (Brown and Ryan 2003) was the most
frequently used questionnaire, being employed in nearly
half of the included studies. Consisting of 15 items, the
MAAS is short and therefore reduces strain on participants
often required to fill out multiple forms and question-
naires. Nevertheless, the validity of the MAAS has been
criticized by several authors. First, the items of the MAAS
are assessing the degree of mindlessness by inquiring
lapses of inattentiveness to the present moment. The item
scores are then reversed to reflect the degree of mindful-
ness. Such a strategy was chosen because mindless states
were considered more accessible for the general population
than mindful states (Brown and Ryan 2003). Grossman
and Van Dam (2011) question the construct validity of the
MAAS by comparing this way of assessment to the mea-
surement of depression assessing participant’sdegreeof
happiness. Second, the relative simple operationalization
of mindfulness as a one-dimensional concept on which
the MAAS is built has been questioned by several au-
thors. They claim that mindfulness is a multi-
dimensional concept comprised of several interacting
factors contributing to mindful functioning (Baer et al.
2004; Baer et al. 2006;Bishopetal.2004). The current
meta-analysis did not find evidence of any differential
sensitivity between the different questionnaires in de-
tecting changes in self-reported mindfulness.
The majority of studies that investigated potential
mediation of self-reported mindfulness on clinical out-
comes demonstrated mediation in the predicted direc-
tion. For example, the mediator analyses showed that
increased self-reported mindfulness was associated with
changes in variables associated with depression, anxiety,
and general stress. This supports the construct validity
of the questionnaires, as the increased capacity of
present-oriented, non-judgmental awareness lead to pos-
itive changes in clinical outcomes and quality of life. It
also supports the hypothesis that self-reported mindful-
ness works as a potential mechanism of change in
interventions. It should be mentioned, however, that
other mechanisms of change of MBIs have been sug-
gested. One example is self-compassion, which refers to
the attitude of openness, caring, and kindness toward
oneself in episodes of suffering, inadequacies, and fail-
ures (Neff 2003). Preliminary evidence suggests that
self-compassion may be a mechanism of change in
MBIs (Kuyken et al. 2010). The mindfulness training
offered in MBIs may teach participants another way of
relating to adversity, thus contributing to the alleviation
of suffering through the development of a kinder and
more accepting view of oneself and one’s experience
(Van Dam et al. 2010). Furthermore, it has been sug-
gested that self-regulation, i.e., the maintenance of sta-
bility of functioning and adaptability to change, may be
a contributor to the positive changes in MBIs (Shapiro
and Carlson 2009). Mindfulness training may contribute
to less experiential avoidance, by enabling a wider,
more adaptive range of coping skills. Finally,
decentering has been suggested as a possible mechanism
of change in MBIs. Defined as the ability to observe
one’s thoughts and feelings as temporary, objective
events in the mind, as opposed to reflections of the self
that are necessarily true, the concept of decentering is
highly overlapping with mindfulness (Fresco et al.
2007). Preliminary evidence suggests that decentering
may work as a mechanism of change in MBIs
(Bieling et al. 2012).
The present meta-analysis demonstrated that within-
group, pre-post estimate was in the medium range for
increasing self-reported mindfulness (Hedges’g=0.53).
This effect is larger than the result from a previous
meta-analysis, which found a small effect of mindfulness
training on self-reported mindfulness in non-clinical sam-
ples (Eberth and Sedlmeier 2012). Post-intervention to
follow-up calculations indicated that the gains were
maintained over time. This indicates that participation
in an MBI leads to stable increases in self-reported
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0
0.0
0.1
0.2
0.3
0.4
0.5
Standard Error
Hedges' g
Fig. 5 Funnel plot of standard error by Hedges’g
Mindfulness

mindfulness, supporting the notion of mindfulness as a
trait-like tendency that can be modified by practice. The
high number of trials reporting non-significant findings
should be commented upon. Over half of the included
trials (37 of 72) found no significant increase in self-
reported mindfulness from pre- to post-treatment. This is
probably due to the fact that majority of the included
studies were uncontrolled studies or pilot investigations
with small samples sizes, making them insufficiently
powered to detect potential effects of treatment.
According to Kazdin (2003), at least 32 participants are
required in an experimental condition to detect a medium
effect size at a .05 confidence level. It is a concern that
of the included studies, only 30 fulfill these criteria. The
between-group analysis with waiting-list controls sup-
ported the hypothesis that mindfulness training leads to
increased self-reported mindfulness. Effect sizes were
typically in the predicted direction, i.e., participants in
MBIs increased their self-reported mindfulness, while
participants not receiving any intervention did not. A
surprising finding in the present meta-analysis was that
participants in active control groups increased their self-
reported mindfulness as much as participants cultivating
mindfulness in the MBIs. Several factors may explain
this finding. First, similarities in the nature of the inter-
ventions in the active control conditions might have
influenced the outcome. Five of the active control groups
included exercises that might affect similar psychological
processes as mindfulness practices, including concentra-
tion exercises (Kingston et al. 2007;Ortneretal.2007;
Shapiro et al. 2008) and progressive muscle relaxation
(Agee et al. 2009; Schmidt et al. 2010). The former may
increase ability to regulate and sustain attention, while
the latter may increase participant awareness of bodily
sensations and non-reactivity, both of which are key
features of the definition of mindfulness. One study
(Brewer et al. 2009) comparing an MBI to group cogni-
tive behavior therapy did favor the MBI condition, but
the between-group effect size was not significant most
likely due to the small sample size. Consequently, it
becomes difficult to assess the unique contribution of
mindfulness training in the facilitation of self-reported
mindfulness. Second, the findings may also indicate that
mindfulness is a universal inherent capacity that poten-
tially may be altered through other methods than mind-
fulness meditation (Brown and Ryan 2004). The capac-
ity of mindful awareness may represent both a trans-
theoretical and trans-diagnostic process that could ac-
count for positive outcomes across interventions and
therapies (Baer 2007). For example, cognitive
restructuring in cognitive therapy may promote a non-
judgmental attitude toward present experience. A final
explanation may be that mindfulness questionnaires are
subject to low construct validity. Some authors have
suggested that the definitions on which the self-report
measurements are built are too simplified compared to
the origin of the concept (Rapgay and Bystrisky 2009).
The ancient theory and practice on which the concept of
mindfulness is based on is much more complex and advanced
than the modern conceptualization of mindfulness.
Consequently, though designed to assess mindfulness, the
questionnaires may be measuring a more general capacity that
improves with many forms of treatment, and not mindfulness
per se. This potential lack of construct validity is a major
concern for the research of mindfulness. Logically, it is difficult
to argue that mindfulness questionnaires measure both trans-
theoretical phenomenon common to most psychotherapies and
mindfulness per se. In order to validate the questionnaires
designed to measure mindfulness, it needs to be more clearly
demonstrated that MBIs uniquely affect self-reported mindful-
ness when compared to active control conditions.
The moderator analyses showed that features of the trials,
including study design, sample characteristics, type of MBI,
total intervention time, and number of sessions did not mod-
erate the overall effect size. The subgroup analysis of the
questionnaires indicated that the questionnaires did not differ
in terms of sensitivity of change. This indicates that all ques-
tionnaires are equivalent in terms of detecting change in self-
reported mindfulness as a result of mindfulness training.
A novel finding was that the inclusion of retreats as part of
the intervention significantly affects self-reported mindful-
ness. Retreats therefore represent an opportunity for partici-
pants to deepen and elaborate their mindfulness skills,
resulting in increased self-reported mindfulness. The review
yielded that the majority of studies excluded retreats without
explicitly stating the reasons for this. One study stated that the
retreat was excluded to minimize strain on participants (Klatt
et al. 2009).Segaletal.(2013) have pointed out that retreats
may be difficult to include in trials investigating health eco-
nomics, as the extra time commitment will deviate from other
therapies. Furthermore, in active control conditions, the total
intervention time should be similar across control groups. The
retreats are therefore excluded, as other forms of therapy
typically do not include a whole day of intervention-specific
activities.
Methodological Limitations
Although the present review identified and selected eligible
studies through a systematic literature search and extensive
review of reference lists, potentially eligible studies may not
have been detected in the search process. Nevertheless,
the analyses of publication bias suggest that the results
are unbiased.
Another limitation of the present paper is the study
characteristics of the included studies. A majority of the
Mindfulness

studies were uncontrolled, and about half of them attained
non-significant effect sizes, possibly due to small sample
sizes. Clearly, larger and more well-designed studies are
called for to more robustly assess the effect of MBIs on
self-reported mindfulness as well as on other outcome
measures. Conversely, uncontrolled studies may offer ad-
vantages with respect to ecological validity. One example
is the selection criteria in controlled studies, which may
not reflect “real world”clinical practice. It can thus be
argued that uncontrolled trials, in a better way, mimic real
client populations to which MBIs are actually administered
(Walach et al. 2006a,b).
A further point concerns the quality of the interven-
tions provided in the included studies. Major sources of
bias may result from non-standardized treatment proto-
cols and non-adherence to manuals by facilitators
(Kazdin 2003). The present review yielded a consider-
able variation within MBIs, but only two studies
assessed facilitators’competence and whether they
followed the treatment manuals (Altmaier and Maloney
2007;Baumetal.2010). Furthermore, descriptions of
treatment protocols were often vague. It is therefore not
clear whether the quality of interventions was subject to
systematic variation.
Moreover, a shortcoming regarding the mediation anal-
ysis of the included studies was the lack of temporal
investigation. A mediator variable should increase during
treatment, and effects of this increase should be observed
after the increase of the mediator (Kraemer et al. 2002).
None of the studies demonstrated that increase in self-
reported mindfulness preceded changes in the outcome
variables, thereby precluding definite causal inferences.
However, a recent study including weekly assessments of
self-reported mindfulness demonstrated increases in self-
reported mindfulness before decreases in perceived stress
(Baer et al. 2012).
Finally, some authors have argued that mindfulness
cannot be captured by self-report questionnaires
(Grossman and Van Dam 2011). It is still uncertain
how one might best capture the central quality of mind-
fulness by self-report measures. However, other complex
psychological variables have successfully been opera-
tionalized and measured using such methodology. As
this review and meta-analysis has demonstrated, it is a
potential weakness of current mindfulness questionnaires
that they do not capture changes uniquely associated
with mindfulness training offered in MBIs. While a
number of unresolved issues remain, it, nevertheless,
seems premature to entirely dismiss the possibility of
assessing the phenomenon by self-report. Instead, fur-
ther conceptual and empirical investigation should be
pursued in order to clarify the meaning of the construct
and its measurement.
Future Directions
Results from the present review indicate that continued inves-
tigations of the assessment of mindfulness are required. As for
study characteristics, further investigations through random-
ized controlled trials with larger sample sizes should be carried
out in order to ensure that studies are adequately powered to
detect reliable and significant effect sizes. Furthermore, inter-
ventions used in active control conditions should be different in
terms of hypothesized mechanisms of change, making it easier
to attribute changes in MBIs to the processes of mindfulness. It
would be interesting to investigate whether participation in an
intervention based on cognitive behavior therapy would affect
self-reported mindfulness, to further test the construct validity
of mindfulness questionnaires. It would also be of interest to
investigate whether mindfulness may be a primary mechanism
of change in other forms of therapy. Forthcoming studies would
also benefit from increased standardization of interventions,
including competence and compliance assessment to study
validity and confidence (Baer 2003).
The inclusion of several data collection points during the
delivery of intervention should be included to detect temporal
sequences of change; i.e., that reported change in self-reported
mindfulness precedes changes in other clinical variables. It
would also be of interest to further investigate the
relation between mindfulness and other overlapping con-
structs like self-compassion, self-regulation, and
decentering. It will be important to the field of mind-
fulness assessment to further clarify the relationship of
mindfulness to these types of processes or mechanisms.
There is evidently some conceptual overlap between
measures, as questionnaires such as FFMQ incorporates
elements of self-compassion, while MAAS relies on the
conceptual foundation of self-determination theory em-
phasizing attentional and behavioral self-regulation.
Further research is needed to delineate to what extent
such mechanisms should be seen as aspects of the
construct of mindfulness or rather as self-contained con-
structs best measured separately.
The moderator analysis showed that inclusion of retreats
increase self-reported mindfulness. Hence, future trials should
consider the inclusion of retreats because of its beneficial
effects in cultivating self-reported mindfulness.
Conclusion
The present review and meta-analysis provides evidence
that MBIs are beneficial for several samples in terms of
increased self-reported mindfulness. However, the study
has also pointed out several methodological issues and
limitations, which should be considered in the planning
of future trials.
Mindfulness

Ta b l e 4 Main findings and characteristics for included studies
Study characteristics Sample characteristics Intervention characteristics Outcome
Author (year) Design Control condition Sample type No. of subjects
(mean age)
Type No. of sessions/
length (min)
Retreat Mindfulness questionnaire
Agee et al. (2009) RCT Active: progressive muscle
relaxation
Non-clinical: community sample 19 (41.63) Mindfulness meditation
(MM)basedonMBSR
5 (60) Not reported MAAS
Altmaier and
Maloney
(2007)
UCT –Non-clinical: recently divorced
parents
14 (33.58) Mindful parenting program
(MPP)
12 (150) Not reported TMS-10
Anderson et al.
(2007)
RCT Waiting-list Non-clinical: healthy adults 46 (37) MBSR 8 (120) Not reported TMS-10
Baum et al. (2010) RCT Treatment as usual:
antidepressant treatment
Affective disorders: depression 61 (48.95) MBCT 8 (120) Not reported KIMS
Birnie et al. (2010)UCT –Somatic disorders:
cancer
82 (62.9) MBSR 8 (90) Half day MAAS
Bowen et al.
(2009)
RCT Treatment as usual: 12-step
abstinence program
Addictive disorders: alcohol and
drug use
93 (40.5) Mindfulness-based relapse
prevention (MBRP)
8 (120) Not reported FFMQ
Brewer et al.
(2009)
RCT Active: cognitive group
therapy
Addictive disorders: alcohol and/
or cocaine dependence
21 (35.6) MBRP (adapted) 8 (60) Not reported FFMQ
Brown et al.
(2011)
RCT Treatment as usual:
individual or group
psychotherapy and/or
psychotropic medication
Heterogeneous disorders: mainly
mood and anxiety disorders
50 (15.7) MBSR (adapted for
adolescents)
8 (not reported) Not reported MAAS-A
Bränström et al.
(2010)
RCT Waiting-list Somatic disorders: cancer 32 (51.8) MBSR 8 (120) No FFMQ
Bögels et al.
(2008)
UCT Active: mindful parenting
training for parents
Adolescents diagnosed with
conduct disorders, pervasive
development disorders,
Asperger’s syndrome, ADHD,
or ODD
14 (14.4) MBCT 8 (90) Not reported MAAS
Carmody and
Baer (2008)
UCT –Heterogeneous disorders: stress,
chronic pain, anxiety
206 (47.05) MBSR 8 (150) Full FFMQ
Carmody et al.
(2009)
UCT –Heterogeneous disorders: stress,
chronic pain, anxiety
320 (49.5) MBSR 8 (150) Full FFMQ
Carmody et al.
(2006)
UCT –Somatic disorders: women with
hot flashes
18 (53.65) MBSR 8 (150) Full TMS-10
Carmody et al.
(2008)
UCT –Heterogeneous disorders 62 (47.8) MBSR 8 (150) Full TMS-10 and MAAS
Chadwick et al.
(2009)
RCT Waiting-list Psychotic disorders 11 (41.6) Person-based cognitive
therapy (PBCT)
10 (not reported) Not reported SMQ and SMVQ
Cohen-Katz et al.
(2005)
RCT Waiting-list Non-clinical: nurses 14 (46) MBSR 8 (150) Full MAAS
Collard et al.
(2008)
UCT –Non-clinical: university students 20 (not reported) MBCT 8 (120) Not reported FMI-14
Appendix A
Mindfulness

Ta b l e 4 (continued)
Study characteristics Sample characteristics Intervention characteristics Outcome
Author (year) Design Control condition Sample type No. of subjects
(mean age)
Type No. of sessions/
length (min)
Retreat Mindfulness questionnaire
Cusens et al.
(2010)
UCT –Somatic disorders: chronic pain 13 (46.7) Breathworks mindfulness-
based pain management
program
10 (150) Not reported MAAS
Dalen et al. (2010)UCT –Somatic disorders: obesity 10 (44) Mindful Eating and Living
(MEAL)
6 (120) Not reported KIMS
Deyo et al. (2009)UCT –Heterogeneous disorders: various
psychological and medical
problems
34 (44) MBSR 8 (not reported) Not reported KIMS
Dobkin (2008)UCT–Somatic disorders: cancer 13 (54) MBSR Not reported (not
reported)
Not reported MAAS
Duncan and
Bardacke
(2010)
UCT –Non-clinical: pregnant women 35 (34.61) Mindfulness-based childbirth
and parenting program
(MBCP)
10 (180) Full FFMQ (3 subscales: act
with awareness, non-
judgment, and non-
reactivity)
Eisendrath et al.
(2008)
UCT –Affective disorder: treatment-
resistant depression
55 (not reported) MBCT 8 (120) Not reported FMI-30
Evans et al. (2010)UCT –Non-clinical: community-based
sample
14 (48) MBSR 8 (120) Not reported MAAS
Evans et al. (2008)UCT –Anxiety disorder: generalized
anxiety disorder
12 (49) MBCT 8 (120) Not reported MAAS
Foley et al. (2010) RCT Waiting-list Somatic disorders: cancer 55 (54.82) MBCT 8 (120) Full FMI-14
Frewen et al.
(2008)
UCT –Heterogeneous disorders:
treatment-seeking students
with mild to moderate mood,
anxiety, and/or stress disorders
43 (not reported) Mindfulness meditation-
based clinical intervention
(MMCI)
8(120–150) Not reported KIMS and MAAS
Garland et al.
(2010)
RCT Active control: evidence-
based alcohol
dependence support
group (ASG)
Substance abuse disorders:
alcohol dependence
27 (39.9) Mindfulness-oriented
recovery enhancement
(MORE)
10 (not reported) Not reported FFMQ
Gross et al. (2010) RCT Waiting-list Somatic disorders: organ
transplant recipients
55 (55) MBSR 8 (150) Full MAAS
Gökhan et al.
(2010)
UCT Active control:
experimental
psychology course
Non-clinical: students 22 (24.8) 6-week MBSR 6 (20) Not reported KIMS, MAAS, and FMI-14
Huppert and
Johnson (2010)
UCT Treatment as usual: religion
study lessons
Non-clinical: adolescent boys 78 (14–15) 4-week MBSR 4 (40) Not reported CAMS-R
Hölzel et al.
(2011)
UCT Waiting-list Non-clinical: self-reported
psychological and physically
healthy individuals
18 (37.89) MBSR 8 (150) Full FFMQ
Kaufman et al.
(2009)
UCT –Non-clinical: community sample
active in sports
32 (52.19) Mindful sport performance
enhancement (MSPE)
4(150–180) Not reported KIMS and TMS-13 (latter
excluded from meta-
analysis)
Kimbrough et al.
(2010)
UCT –Child abuse survivors 27 (45) MBSR 8 (150–180) Full MAAS
Mindfulness

Ta b l e 4 (continued)
Study characteristics Sample characteristics Intervention characteristics Outcome
Author (year) Design Control condition Sample type No. of subjects
(mean age)
Type No. of sessions/
length (min)
Retreat Mindfulness questionnaire
Kingston et al.
(2007)
RCT Active control: 2 sessions of
guided visual imagery
Non-clinical: university students 21 (23) Stress-reduction classes 6 (60) Not reported KIMS
Klatt et al. (2009) RCT Waiting-list Non-clinical: university staff 24 (43.41) Low-dose MBSR (MBSR-ld) 6 (60) No MAAS
Kocovski et al.
(2009)
UCT –Anxiety disorders: social anxiety 42 (34.17) Mindfulness and acceptance-
based group therapy
(MAGT)
12+ 1 follow-up
post treatment
(120)
Not reported KIMS and MAAS
Krasner et al.
(2009)
UCT –Non-clinical: primary care
physicians
70 (not reported) Intervention based on MBSR 18 (150) Full FFMQ (factors observe and
non-react)
Labelle et al.
(2010)
UCT Waiting-list Somatic disorders: women with
cancer
46 (53.1) Mindfulness-based cancer
recovery
(MBCR)
8 (90) Full MAAS
Lau et al. (2006)UCT –Heterogeneous disorders: mood,
anxiety, pain, cancer, stress
99 (46.68) MBSR 8 (not reported) Not reported TMS-13
Lovas and Barsky
(2010)
UCT –Anxiety disorders:
hypochondriasis/severe health
anxiety
10 (35.6) MBCT 8 (120) Not reported FFMQ
Matchim et al.
(2010)
UCT Passive Somatic disorders: cancer 19 (56.87) MBSR 8 (120–160) Full FFMQ
Matousek and
Dobkin (2010)
UCT –Somatic disorders: cancer 59 (56.4) MBSR 8 (150) Full MAAS
Michalak et al.
(2008)
UCT –Affective disorders: major
depression
29 (47.6) MBCT 8 (150) Not reported MAAS
Morone et al.
(2009)
RCT Active: 8-week health
education program
Somatic disorders: elderly with
chronic low back pain
20 (78) MBSR 8 (90) Not reported FFMQ and MAAS
Mularski et al.
(2009)
RCT Active: 8-week support
group
Somatic disorders: elderly with
chronic obstructive lung
disease
44 (70.6) Mind-body breathing therapy
(MBBT)
8 (not reported) Not reported FFMQ
Nyklíček and
Kuijpers
(2008)
RCT Waiting-list Stress/distress disorders 30 (not reported) MBSR Not reported (not
reported)
Not reported KIMS (factors non-
judgment and observe)
and MAAS
Oken et al. (2010) RCT Active: education class
basedonpowerfultools
for caregivers (PTC) and
waiting-list
Non-clinical: dementia caregivers 10 (62.5) Mixed MBSR and MBCT 6 (90) Not reported FFMQ (factor non-
judgment) and MAAS
Ong et al. (2008)UCT –Sleep disorders 30 (36.4) Integrated MBSR and
cognitive behavioral
therapy for insomnia
(MBSR+ CBT-I)
6(90–120) Not reported KIMS
Ong et al. (2009)UCT –Sleep disorders 30 (38.7) MBSR + CBT-I 6 (120) Not reported KIMS
Ortner et al.
(2007)
RCT Active: relaxation
meditation (RM) and
waiting-list
Non-clinical: recruited from an
urban university
28 (not reported) Kilner mindfulness
meditation intervention
(KMMI)
7 (90) Not reported TMS-10 and MAAS
Mindfulness

Ta b l e 4 (continued)
Study characteristics Sample characteristics Intervention characteristics Outcome
Author (year) Design Control condition Sample type No. of subjects
(mean age)
Type No. of sessions/
length (min)
Retreat Mindfulness questionnaire
Pradhan et al.
(2007)
RCT Waiting-list Somatic disorders: rheumatoid
arthritis
31 (56) MBSR 8 (150) Full MAAS
Raes et al. (2009) UCT Waiting-list Non-clinical: recruited from a
mindfulness institute
24 (43.29) MBCT 8 (not reported) Not reported KIMS-E
Ree and Craigie
(2007)
UCT –Heterogeneous disorders:
psychiatric outpatients
26 (39.5) MBCT 8 (150) Not reported MAAS
Rimes and
Wingrove
(2011)
UCT –Non-clinical: trainee clinical
psychologists
20 (not reported) MBCT 8 (not reported) Not reported FFMQ
Sachse et al.
(2010)
UCT –Borderline personality disorde r 22 (no t reported) MBCT adapte d for borderline
personality disorder
(MBCT-a)
8 (150) Not reported FFMQ
Schmidtetal.
(2010)
RCT Active:
Jacobson progressive
muscle relaxation
training and
fibromyalgia-specific
stretching exercises and
waiting-list
Somatic disorders: fibromyalgia 59 (53.4) MBSR 8 (150) Full FMI-14
Schroevers and
Brandsma
(2010)
UCT –Non-clinical: sample from the
local community, no exclusion
criteria
85 (43.23) MBCT 8 (150) Full KIMS (factors non-
judgment and observe)
and MAAS
Shahar et al.
(2010)
RCT Waiting-list Affective disorders: depression 29 (46.58) MBCT 8 (180) Full MAAS
Shapiro et al.
(2007)
UCT Active control: classes in
research methods and
psychological theory
Non-clinical: psychology
counseling students
22 (29.2) MBSR 8 (120) Not reported MAAS
Shapiro et al.
(2011)
RCT Waiting-list Non-clinical: students 17 (18.73) MBSR 8 (not reported) Not reported MAAS
Shapiro et al.
(2008)
RCT Active: Easwaran’seight
point program and
waiting-list
Non-clinical: students 16 (not reported) MBSR 8 (90) No MAAS
Sharplin et al.
(2010)
UCT –Somatic disorders: cancer 25 (51.36) MBCT 8 (120) Not reported FMI-14
Smith et al. (2008) UCT Active: cognitive-
behavioral stress
reduction
Non-clinical: community sample 45 (not reported) MBSR 8 (180) Full MAAS
Smith et al. (2006)UCT –Non-clinical: community sample 27 (47.8) MBSR 8 (180) Full MAAS
Splevins et al.
(2009)
UCT –Heterogeneous: older adults with
various complaints
43 (65) MBCT 8 (120) Not reported KIMS
Vieten and Astin
(2008)
RCT Waiting-list Non-clinical: pregnant women 15 (not reported) Mindful motherhood
intervention (MMI)
8 (120) Not reported MAAS
Mindfulness

Ta b l e 4 (continued)
Study characteristics Sample characteristics Intervention characteristics Outcome
Author (year) Design Control condition Sample type No. of subjects
(mean age)
Typ e No . of s ess io ns/
length (min)
Retreat Mindfulness questionnaire
Vieten et al.
(2010)
UCT –Substance abuse disorders:
alcohol dependence
33 (45) Acceptance-based coping
intervention for alcohol
dependence relapse
prevention (ABCRP)
8 (120) Not reported FFMQ
Vøllestad et al.
(2011)
RCT Waiting-list Anxiety disorders: panic,
agoraphobic, social, and
general anxiety disorders
39 (41.4) MBSR 8 (150) Half FFMQ
Web e r et a l .
(2010)
UCT –Affective disorders: bipolar
depressive disorder
23 (not reported) MBCT 8 (120) Not reported KIMS
Witek-Janusek et
al. (2008)
UCT Assessment only and
cancer-free control
Somatic disorder: women newly
diagnosed with early stage
breast cancer
44 (55) MBSR 8 (150) Full MAAS
Zgierska et al.
(2008)
UCT –Substance abuse: alcohol
dependence
19 (38.4) MBRP 8 (120) Not reported MAAS
RCT randomized controlled trial; UCT uncontrolled trial; MBSR mindfulness-based stress reduction; MBCT mindfulness-based cognitive therapy; MAAS Mindful Attention Awareness Scale; TMS-10
Toronto Mindfulness Scale, 10-item version; KIMS Kentucky Inventory of Mindfulness Skills; FFMQ Five Facet Mindfulness Questionnaire; MAAS-A Mindful Attention Awareness Scale Adolescent;
ADHD attention deficit hyperactivity disorder; ODD oppositional defiant disorder; SMQ Southampton Mindfulness Questionnaire; SMVQ Southampton Mindfulness of Voices Questionnaire; FMI-14
Freiburg Mindfulness Inventory, 14-item version; FMI-30 Freiburg Mindfulness Inventory, 30-item version; CAMS-R Cognitive and Affective Mindfulness Scale Revised; TMS-13 Toronto Mindfulness
Scale, 13-item version; KIMS-E Kentucky Inventory of Mindfulness Skills Extended
Mindfulness

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