Integrating Mindfulness into Positive Psychology: a Randomised Controlled Trial of an Online Positive Mindfulness Program

Abstract

The purpose of the present study was to test the efficacy of an 8-week online intervention-based Positive Mindfulness Program (PMP) that integrated mindfulness with a series of positive psychology variables, with a view to improving well-being scores measured in these variables. The positive mindfulness cycle, based on positive intentions and savouring, provides the theoretical foundation for the PMP. The study was based on a randomised wait-list controlled trial, and 168 participants (128 females, mean age = 40.82) completed the intervention which included daily videos, meditations and activities. The variables tested included well-being measures, such as gratitude, self-compassion, self-efficacy, meaning and autonomy. Pre- and post-intervention data, including 1 month after the end of the intervention, were collected from both experimental and control groups. The posttest measurements of the experimental participants showed a significant improvement in all the dependent variables compared with the pre-test ones and were also significantly higher than those of the control group. One month after the intervention, the experimental group participants retained their improvement in 10 out of the 11 measurements. These positive results indicate that PMP may be effective in enhancing wellbeing and other positive variables in adult, non-clinical populations.

Full text

ORIGINAL PAPER
Integrating Mindfulness into Positive Psychology: a Randomised
Controlled Trial of an Online Positive Mindfulness Program
Itai Ivtzan
1
&Tarl i Yo u n g
1
&Janis Martman
1
&Allison Jeffrey
1
&Tim Lomas
1
&
Rona Hart
1
&Francisco Jose Eiroa-Orosa
1
#Springer Science+Business Media New York 2016
Abstract The purpose of the present study was to test the
efficacy of an 8-week online intervention-based Positive
Mindfulness Program (PMP) that integrated mindfulness with
a series of positive psychology variables, with a view to im-
proving well-being scores measured in these variables. The
positive mindfulness cycle, based on positive intentions and
savouring, provides the theoretical foundation for the PMP.
The study was based on a randomised wait-list controlled trial,
and 168 participants (128 females, mean age = 40.82) com-
pleted the intervention which included daily videos, medita-
tions and activities. The variables tested included well-being
measures, such as gratitude, self-compassion, self-efficacy,
meaning and autonomy. Pre- and post-intervention data, in-
cluding 1 month after the end of the intervention, were col-
lected from both experimental and control groups. The post-
test measurements of the experimental participants showed a
significant improvement in all the dependent variables com-
pared with the pre-test ones and were also significantly higher
than those of the control group. One month after the interven-
tion, the experimental group participants retained their im-
provement in 10 out of the 11 measurements. These positive
results indicate that PMP may be effective in enhancing well-
being and other positive variables in adult, non-clinical
populations.
Keywords Well- bein g .Mindfulness .Meditation .Positive
psychology .Randomised controlled trial .Intervention
program
Introduction
A large body of research has demonstrated that mindfulness
training has positive effects (e.g. Baer et al. 2012;Ivtzanand
Lomas 2016), but the number of mindfulness programs ex-
plicitly aimed at positive psychological changes and increased
well-being is small (Lindsay and Creswell 2015). In addition,
empirical reports have mainly focused on mindfulness inter-
ventions as programs that reduce psychological distress
(Goyal et al. 2014). These programs reflect an existing gap
in the current mindfulness literature: the focus on negative
variables (such as stress and anxiety), while neglecting the
potential role of mindfulness in the enhancement of positive
ones (such as happiness and meaning). The practice of mind-
fulness has been correlated with reduced attentional biases in
response to negative stimuli (Goldin and Gross 2010). And
yet, letting go of the fixation on negative cognitive and emo-
tional responses is not sufficient to promote positive variables
and well-being: B…a complete theory of mindfulness must
account for the cultivation of positive mental states rather than
focus exclusively on the reduction of negative states^
(Garland et al. 2015,p.295).
An area where these questions could be resolved is positive
psychology (PP). Well-being has been studied extensively
within the field of PP (Lomas et al. 2014). More specifically,
positive psychology interventions (PPIs) have been success-
fullyusedtostrengthenpositivementalstatesandavarietyof
well-being variables (Parks and Biswas-Diener 2013).
Kashdan et al. (2015) indicated that mindfulness responses
to stressors and negative events are much more studied than
the effect of mindfulness during positive event processing.
Similarly, Lindsay and Creswell (2015) claimed that new
studies are needed where mindfulness interventions attempt
to increase positive well-being variables as part of the training.
These are gaps that PP could and should address.
*Itai Ivtzan
i.ivtzan@uel.ac.uk
1
Department of Psychology, UEL (University East London), Stratford
Campus, London E15 4LZ, UK
Mindfulness
DOI 10.1007/s12671-016-0581-1

Mindfulness is a form of awareness that arises from attend-
ing to the present moment in a non-judgemental and accepting
manner (Bishop et al. 2004). This state of mind is an invitation
for the practitioner to attend the full range of internal and
external experiences with a non-judgemental stance (Hart
et al. 2013). Studies have shown that mindfulness promotes
both hedonic (Brown and Cordon 2009) and eudaimonic well-
being (Brown et al. 2007). Hedonic well-being is associated
with pain relief and increased pleasure; eudaimonic well-
being stands for living a meaningful, self-realised and fully-
functional life.
Various mindfulness programs have been developed in the
West for clinical populations, the most prominent of which
include mindfulness-based stress reduction (MBSR; Kabat-
Zinn 1982) and mindfulness-based cognitive therapy (MBCT;
Teasdale et al. 2000). As implied by its name, the purpose of
MBSR, originally designed to manage chronic pain, was to
decrease stress, anxiety and depression, while the MBCT aimed
specifically to prevent depression relapses. These programs
have been empirically tested and successfully used to reduce
a variety of symptoms related to disorders such as psychosis
(Bach and Hayes 2002), depression (Teasdale et al. 2000)and
chronic pain (Kabat-Zinn 1982). They focus on reducing neg-
ative variables (such as stress, anxiety and depression), in line
with the traditional Western psychology focus on reducing def-
icits (Seligman and Csikszentmihalyi 2000).
Despite the focus on deficit reduction, Western mindful-
ness programs have also led to improvements in positive var-
iables, such as positive affect (Geschwind et al. 2011), cogni-
tive functioning (Hölzel et al. 2011), positive reappraisal of
thoughts (Hanley and Garland 2014) and improved interper-
sonal interactions (Goleman 2006). This may wrongly suggest
that, because existing deficit-focused mindfulness programs
increase positive variables, there is no need for a separate
mindfulness program focused on positive variables. Such an
approach would be missing the potential benefits embodied in
the combination of PP and mindfulness.
The relationship between mindfulness and PP has been ex-
plored in the past (e.g. Ivtzan and Lomas 2016; Brown and
Ryan 2003), and yet this paper provides a unique theoretical
foundation for the relationship between PPIs and mindfulness.
We propose the positive mindfulness cycle whereby PPIs and
mindfulness influence and enhance each other in a process
leading to improvements in Hedonic and Eudaimonic well-be-
ing. This cyclic process allows mindfulness and PPIs to con-
tinuously enhance each other, thus leading to an increase in an
individual’s well-being which could serve better than the ben-
eficial impact of mindfulness or PPIs as separate practices.
Shapiro et al. (2006) proposed the IAA model of mindful-
ness, as part of which the first element of the model, intention,
creates a specific context and motivation, fuelling mindfulness
practice, in that it connects practitioners with their goals,
vision and aspirations. Shapiro et al. (2006) viewed these
experiences as a vital component of mindfulness and main-
tained that the practitioner’s intention in practising mindful-
ness plays an important role in the very experience of mind-
fulness exercises, and consequently in their outcomes. Kabat-
Zinn (1990) argued that intention is essential in facilitating
positive change through mindfulness: BYour intentions set
the stage for what is possible. They remind you from moment
to moment of why you are practicing in the first place^(p. 32).
Shapiro (1992a) underscored the importance of intention,
showing that the majority of meditators have attained the ef-
fects they had originally aimed for. For example, if they aimed
for self-regulation (control over self), they were more likely to
achieve greater self-regulation, while the intention of self-
exploration (knowledge of self) led to increased self-
exploration.
Parks and Biswas-Diener (2013) outlined a number of rig-
orous parameters for the classification of PPIs, beginning with
a flourishing-based approach according to which PPIs have a
clear goal and intention, to increase positive variables. In re-
ality, the primary intention of all the prominent mindfulness
programs, including the MBSR and the MBCT, was decreas-
ing negative variables; this is a deficit-based approach, whose
point of departure and implied motivation and intention is the
disease model: Human beings are seen as being damaged, in
need of treatment, and we harness mindfulness to that pur-
pose. These programs are therefore not in line with the spirit
of PPIs, whose intentions regard mental health from a differ-
ent angle. In PPIs, mental health does not mean the absence of
mental illnesses; these programs do not consider eliminating
illness as a guarantee that an individual is healthy, thriving and
competent (Ryff and Singer 1998). Keyes (2002) defined
flourishing as the presence of mental health which is a com-
bination of positive functioning and feelings. This state of
flourishing goes beyond the mere elimination of psychologi-
cal distress and can be achieved only if positive variables are
involved. The deficit focus of Western psychology has gener-
ated much research on the ability of mindfulness to reduce
negative variables, but very little research has been dedicated
to mindfulness-based interventions and mechanisms which
boost positive variables.
Garland et al. (2015) proposed the Mindfulness-To-
Meaning theory in order to clarify potential paths through
which mindfulness practice enhances positive variables, mainly
Eudaimonic well-being. As part of their theory, they suggested
that mindfulness practice helps enhance savouring. Savouring
allows us to voluntarily generate, intensify and prolong enjoy-
ment and appreciation (Bryant and Veroff 2007).
AccordingtoRitchieandBryant(2012), mindfulness is a
prominent dimension of savouring. It is through the quality of
befriending and embracing whatever arises that mindfulness
allows one to savour. Savouring is enhanced by mindfulness
practice, in that it involves metacognitive and self-reflective
elements, enabling the individual to be aware of the pleasurable
Mindfulness

aspects of the stimulus as well as the positive emotions that are
triggered while engaged in it (Frijda and Sundararajan 2007).
Mindfulness enables us to monitor on-going sensory and per-
ceptual events, thereby facilitating the noticing and apprecia-
tion that allows savouring (Lindsay and Creswell 2015).
In our everyday lives, pleasant events outnumber unpleas-
ant ones by a ratio of 3 to 1 (Oishi et al. 2007); therefore, most
moments in life have the potential to be experienced as posi-
tive. However, we essentially need to be aware of these pleas-
ant moments in order to enjoy them. Without being mindfully
aware of a positive experience, an individual will not be able
to savour it. A broad range of studies supported this notion and
indicated that increased attention to sensory experience pro-
motes pleasure in activities, such as sex and eating (Heiman
and Meston 1997), while focusing our full attention on the
actual experience of the moment leads to higher levels of
happiness (Killingsworth and Gilbert 2010). Specifically
linking mindfulness with savouring, mindfulness training in-
creased participants’positive emotions and rewards following
pleasant daily life activities (Geschwind et al. 2011). Mindful
eating studies showed similar results when participants in-
creased liking and enjoyment of food following mindfulness
practice (Hong et al. 2014). Finally, Loving-Kindness-
Meditation (LKM) studies have displayed similar results
(Fredrickson et al. 2008).
In the context of PPIs, it is important to remember
that experiencing positive events or emotions does not
automatically mean that an individual can fully savour
them. The management of positive experiences and
emotions requires—beyond the feeling of pleasure,
meaning, or any other positive variable—the capacity
to find, regulate, manipulate and sustain them.
Therefore, in order to fully utilise the benefits of PPIs,
savouring is required. This understanding underlines the
fact that mindfulness, which boosts savouring, enhances
the benefits of PPI practice.
To find out whether participation in an online Positive
Mindfulness Program (PMP) actually increased well-be-
ing, 11 variables were measured for changes: nine well-
being variables (mindfulness, gratitude, self-compassion,
autonomy, self-efficacy, presence of meaning, well-be-
ing—happiness index, compassion for others and engage-
ment) and two psychological distress variables (depres-
sion and perceived stress). While focusing on positive
variables, the present study examined whether the PMP
is also able to reduce depression and perceived stress, two
major deficiency-based negative variables. We
hypothesised that participants who received the PMP
training would show significant improvements in both
well-being variables and psychological distress variables.
A secondary hypothesis was that participants with lower
levels of well-being and higher levels of depression will
benefit to a greater extent from the program.
Method
Participants
The study used a randomised wait-list controlled design.
Our main between-group independent variable was the
allocation to a control or an experimental group. A con-
venience sample, composed by three different population
groups, was targeted in the recruitment process: educa-
tors, office workers and meditators. BEducators^included
peoplewhowereeducatingothersinagroupsetting,e.g.
school teachers. BOffice workers^were people working
for at least 7 h a week in an office setting. BMeditators^
were people who had meditated at least once a week for at
least 1 year. Meditation, in this context, was defined as
any activity where a conscious attempt is made to focus
attention in a non-analytical way; examples included
breathing and walking meditation, body-scan, and yoga.
The inclusion of this subsample intended to allow
analysing whether previous practice of meditation had
buffering effects on the results.
The sample size was calculated accepting an alpha risk
of0.05andabetariskof0.2inatwo-sidedtestwitha
minimum correlation coefficient between the initial and
final measurement of 0.5. Foreseeing a dropout rate twice
as high in the control compared with the treatment group,
in order to recognise as statistically significant a differ-
ence greater than or equal to 0.5 standard deviations (ef-
fect chosen as a way to make the study feasible), 48 par-
ticipants were necessary in the experimental group and 95
participants were necessary in the control group. The ex-
perimental procedure was carried out until these numbers
were achieved.
Participants were recruited online through social networks
and forums. The program was advertised as voluntary and was
described as a combination of mindfulness and positive psy-
chology exercises. No incentives were offered. Four hundred
fifty-five participants were initially recruited, of whom 15
were excluded for severe levels of depression (as measured
with the Beck’s depression inventory (BDI) cut off established
by Beck et al. 1996) following initial completion of question-
naires. This screening was deemed necessary based on studies
indicating that meditation can have adverse effects on severely
depressed individuals (Shapiro 1992b). Another criterion ex-
cluded participants under the age of 18, but none appeared on
the initial recruit list.
Of the remaining 440 participants, 394 completed at least
one questionnaire. The number of participants who completed
all the questionnaires finally reached 168; 115 were in the
control group and 53 in the experimental group. The partici-
pants included citizens of 20 countries, with most of them
from the UK (32 %), Canada (24 %), the USA (13.5 %) and
Australia (11 %). All participants were English-speaking.
Mindfulness

Procedure
The Positive Mindfulness Program (PMP) introduced in this
paper is an 8-week online program, which combines mindful-
ness training with various PPIs and theoretical aspects to boost
well-being in the general population. This is the result of a
long trajectory of research that was piloted with university
students before being implemented in this study. Each of the
eight PMP weeks focused on a different topic: (1) self-aware-
ness, (2) positive emotions, (3) self-compassion, (4) self-
efficacy (strengths), (5) autonomy, (6) meaning, (7) positive
relations with others and (8) engagement (savouring). These
topics address both hedonic and eudaimonic well-being. For
example, mindfulness increased both hedonic and eudaimonic
well-being (Brown et al. 2007). Engagement and gratitude
increased positive emotions (McCullough et al. 2002) that
promote hedonic well-being (Deci and Ryan 2008). The other
positive variables promoted eudaimonic well-being based on
the psychological well-being (PWB) model (Ryff and Keyes
1995). The model outlined six dimensions of well-being, five
of which are included in the PMP: self-acceptance (self-com-
passion), autonomy, environmental mastery (self-efficacy),
purpose in life (meaning) and positive relations with others.
At the beginning of each week, the experimental partici-
pants were given an 8–10-min video, which summarised the
theoretical basis of the weekly topic. They were also given a
12-min audio file which contained a daily guided meditation
running for about 10 min, and an additional 2-min brief daily
activity related to the week’s topic (see Table 1). These daily
meditations are at the core of the PMP, and yet, the program
requires a third stage: daily practice. This daily practice was an
invitation for the participants to apply the insights, internal
experiences and knowledge triggered by the daily meditations
to their everyday lives. Many spiritual teachers emphasise the
importance meditation acquires once it becomes an integrated
aspect of life rather than an island within our daily activities
(e.g. Krishnamurti 1975). The daily practice included in the
PMP was an important bridge connecting the daily medita-
tions with the participants’daily life, allowing them to apply
their meditative insights.
A written transcript of the meditations and daily activities
was also provided. The PMP is fully protocoled, including all
the materials used for the videos, daily meditations, and daily
activities. The videos and meditations were created by a team
of researchers, who are the authors. With 20 years of mindful-
ness mediation practice and over 15 years’experience teach-
ing a broad range of meditation techniques (including mind-
fulness meditation), the leading author recorded the sessions.
The weekly topics and activities are summarised in Table 1.
How are PP and mindfulness amalgamated in the PMP?
The daily PMP sessions involved two dimensions. The first is
based on PP exercises or interventions, where participants
engaged with their own strengths and virtues. In this stage,
approximately half of the set practice time was dedicated to
the exercise, creating a positive inner experience that is both
cognitive and emotional. This first dimension may elicit, for
example, positive emotions, a sense of autonomy, intensified
personal meaning in life, greater connection with one’s
strengths or a deep feeling of self-compassion. Once the en-
gagement with the PPI has been completed, the practice
shifted to the second dimension: mindfulness. As is common-
ly the case in mindfulness practice, participants simply ob-
served their inner experience without reacting to it. These
dimensions have been repeated throughout the intervention,
where participants moved from a PPI into mindfulness, back
to a PPI leading to mindfulness, creating the positive mindful-
ness cycle. As part of the cycle, a flourishing-based intention
was created through the PPI, enhancing mindfulness, while a
deeper level of savouring towards the PPI was provided
through mindfulness.
This process could have enhanced participants’well-being,
as part of the PMP, as it utilised further the benefits of both
practices. For example, in the sixth week, participants per-
formed a daily exercise designed to boost meaning in life
and create greater awareness of this meaning. They began
with practising the Bbest possible self^intervention (King
2001) for approximately 5 min, to trigger insights related to
aspects of the self which could lead to higher levels of mean-
ing and purpose. This has been the process of intention setting.
Once it has been completed, participants continued with 5 min
of mindfulness practice, during which they engaged non-
reactively and non-judgementally with thoughts and sensa-
tions in the body that have been triggered by their own expe-
rience of their best possible self. This is the process that in-
creased the level of savouring towards the experience of their
best possible self. The daily practice allowed gradual growth
of the positive cycle, enhancing its benefits.
Following recruitment, participants received an invitation
letter by email, outlining the program which contained a link
to a designated online platform. Participants were asked to
complete the consent form and were screened for depression.
After filling in that information, participants were randomly
distributed into experimental and control groups and were
then sent an email containing instructions for further partici-
pation. Randomisation was executed by means of predefined
lists (440 numbers, range 1–2, balanced) created automatical-
ly by the study’s website. Participants who passed the screen-
ing completed a one-page demographic questionnaire and the
11-scale questionnaire that provided the pre-test data.
Participants were also requested to indicate their experience
with meditation (number of years). Mean completion time was
25 min.
After the pre-test stage, the experimental and control
groups followed a different procedure. The experimental
group began the PMP immediately: The participants were
invited to watch the videos and then proceed with the
Mindfulness

meditation and the other indicated practice every day for the
next week. A practice-reminder email was sent to the partici-
pants after 3 days, and another one was sent after 7 days,
inviting them to login and carry on with the program. Once
logged-in, they were asked to report how frequently they had
completed the meditation and daily activity during the week.
To assist this process, they were provided with a tracking
table. The participants then completed the relevant scales for
the week and went on to the video and audio file of the next
week. This process continued for 8 weeks. At the end of the
program, the participants completed again the same 11 scales
to provide post-test measures. This was repeated 1 month later
to provide a longitudinal perspective. Participants needed to
view the videos of all sessions and listen to all audio medita-
tions at least once, in order to receive the post-treatment as-
sessments. Meanwhile, the control group was informed that
they were on a Bwait-list^and could start the program in
3 months. Eight weeks later, they were asked to complete
the 11 scales. This was repeated after another 4 weeks
(12 weeks in all), providing two measures, a month apart,
which parallel with the post-tests of the experimental group.
They were then given access to the PMP.
The research was approved by the Institutional Ethics
Review Board of the University of East London. Following
completion, both control and experimental participants were
provided with a debrief letter, explaining the aims of the pro-
gram. Figure 1shows a flow chart of the procedure and par-
ticipant numbers.
Measures
Outcome variables were measured by quantitative self-
reported scales that were completed online. Eleven scales
were used as pre- and post-measures. The post-measures were
taken at the completion of the program and 1 month later. The
experimental group also completed the Pemberton Happiness
Index—Experienced Well-being Subscale (Hervás and
Vázquez 2013) and the average of minutes meditating per
day on every week of the program.
The Pemberton Happiness Index (PHI) (Hervás and
Vázquez 2013) is a 21-item scale that measures eudaimonic
and hedonic well-being. It has two subscales: remembered
well-being (PHI-RW) and experienced well-being (PHI-
EW). The PHI-RW is made of retrospective questions, scored
Tabl e 1 Outline of PMP eight weekly topics and activities
Week Variable Theory video Meditation Daily practice
1 Self-awareness Introduction to mindfulness, self-
awareness, positive psychology
and meditation
Introductory meditation focusing on
awareness of breath, body and
emotions
Keeping aware of thoughts and
reactions throughout the day
2 Positive emotions Discussion of the benefits of positive
emotions and gratitude
Gratitude meditation focusing on
who or what one appreciates
Expressing gratitude for positive
situations
3 Self-compassion Explanation of the self-compassion
concept, research review and
methods to increase self-
compassion
Adapted version of Loving Kindness
meditation focusing on self-
compassion (Neff and Germer
2013)
Replacing internal criticism with
statements of kindness
4 Self-efficacy Introduction to character strengths
and self-efficacy including en-
hancement methods
Meditation focusing on a time when
participant was at his/her best and
using character strengths
Completing the Values in Action
(VIA) character strengths survey
and using strengths
5 Autonomy Introduction to autonomy and its
connection with well-being
Meditation on authentic self and
action
Taking action in line with one’s
values and noticing external
pressure on choices
6 Meaning Discussion of meaning and well-
being. Completion of writing
exercise, BBest Possible Legacy^
adapted from the Obituary
Exercise (Seligman et al. 2006)
Meditation on future vision of self,
living one’s best possible legacy
Acting according to best possible
legacy. Choosing meaningful
activities
7 Positive relations
with others
Discussion of benefits of positive
relationships and methods for
relationship enhancement
Loving Kindness Meditation Bringing feelings of loving kindness
into interactions
8 Engagement Introduction to engagement and
savouring and their connection
with positive emotions
Savouring meditation focusing on
food
Using savouring to engage with
experiences
Conclusion Summary of the program.
Discussion of personal growth
and invitation to keep meditating
Mindfulness

on a 10-point Likert scale. The PHI-EW comprises ten Byes^
or Bno^questions that measure well-being in the preceding
24 h, with good internal reliability (α= 0.897) at baseline.
The Perceived stress scale (PSS) (Cohen and Williamson
1988) measures perceived stressful situations. It is made of 10
items scored on a 5-point Likert scale, with good internal
reliability (α=0.906).
The Beck’s depression inventory-II (BDI-II) (Beck et al.
1996) measures depression over 21 items. It is scored on a
4-point Likert scale, with good internal reliability (α=0.816).
Mindfulness was assessed using the Freiburg mindfulness
inventory (FMI) (Walach et al. 2006). The FMI is a 14-item
scale, scored on a 4-point Likert scale, with good internal
reliability (α=0.907).
The Gratitude questionnaire, 6-item form (GQ6) comprises
six items which measure the respondents’disposition to feel
gratitude (McCullough et al. 2002). It is scored on a 7-point
Likert scale with good internal reliability (α=0.843).
The Self-compassion scale (SCS) short-form (Raes et al.
2011) measures the ability to approach one’s suffering with
warmth and concern. It has 12 items scored on a 5-point Likert
scale, with good internal reliability (α=0.875).
The Psychological well-being autonomy subscale (APWB)
is a 14-item subscale of the PWB scale (Ryff and Keyes
1995). It measures the respondents’ability to resist social
pressures and remain independent, as well as their self-
regulating capabilities. The scale is scored on a 6-point
Likert scale with good internal reliability (α=0.898).
The Generalised self-efficacy scale (GSE) (Schwarzer and
Jerusalem 1995) is a 10-item scale that measures perceived
self-efficacy in dealing with stressors. It is scored on a 4-point
Likert scale, with good internal reliability (α=0.896).
The Meaning in life questionnaire: presence subscale
(MLQ-P) (Steger et al. 2006) measures perceived presence
of meaning in life. It comprises five items, scored on a 7-
point Likert scale with good internal reliability (α=0.927).
The 24-item Compassion for others scale (COS) (Pommier
2011) measures compassion for others using three factors:
kindness, common humanity and mindfulness. It is scored on
a 5-point Likert scale with good internal reliability (α= 0.875).
Randomised (N=440)
Assessed for eligibility (N= 455)
Excluded
Screened positive for depression (N=15)
Enrolment
Completed post assessment (N=53)
Followed up at one moth (N=35)
Assigned to experimental group (N=220)
Did not complete any pre-test scal es (N=8)
Completed week 1 (N=134)
Completed week 2 (N=122)
Completed week 3 (N=109)
Completed week 4 (N=96)
Completed week 5 (N=81)
Completed week 6 (N=69)
Completed week 7 (N=65)
Completed post-test scales (N=115)
Followed up at one moth (N=43)
Assigned to control group (N=220)
Did not complete any pre-test scales (N=38)
Assignment
Follow-Up
Fig. 1 Participant flow diagram
Mindfulness

The Appreciation inventory scale: present moment sub-
scale (APM) (Adler and Fagley 2005) measures the respon-
dents’appreciation of their surroundings. It has seven items,
scored on a 7-point Likert scale with good internal reliability
(α=0.905).
Data Analyses
The reliability of the scales at baseline was checked by
using Cronbach’s alpha coefficients. To examine wheth-
er randomisation achieved its purpose, independent sam-
ples ttests (two-tailed) and chi-squared tests were run
to analyse differences in demographics and pre-test out-
come results between the experimental and control
groups.
Mixed-design analyses of variance (split-plot ANOVAs
or RM ANOVAS) were run on the pre- and post-scores of
each scale, comparing the evolution of experimental and
control groups over three points in time and examining
the group × time interaction in a per protocol fashion.
Additional independent samples ttests were used as a
way of illustrating static differences between the two
groups over the follow-up points. In order to carry out
intent-to-treat analyses (Moher et al. 2001), five multiple
imputations were used to fill in for missing information
on participants with at least baseline data. These imputa-
tions enabled mixed-design ANOVAs with three observa-
tions (ten in the case of the PHI experienced well-being
subscale, in order to have an alternative unbiased version
of Fig. 2,seebelow).
RM ANCOVAS were used to analyse the effects of the
meditation experience and of the frequency of meditation
and daily practice as well as baseline well-being and de-
pression on the evolution of outcomes. All analyses were
completed with a significance of p< .05, using SPSS 20
for Windows.
Results
As outlined in Table 2, no significant differences were ob-
served between the experimental and control groups, in terms
of key socio-demographic variables. Regarding the differ-
ences between completers and non-completers, completers
scored significantly higher on the FMI (Mindfulness, t=
2.10, MD = 1.980, p= .036) and the COS (Compassion for
others, t= 2.269, MD = 1.874, p= .024) in pre-tests, com-
pared with non-completers. There were no significant differ-
ences on the other 10 scales. More control group participants
completed (52 %), compared with experimental participants
(24 %).
In our study, all scales showed good internal reliability,
with Cronbach alphas ranging from 0.816 to 0.927 (see above
in the description of the scales for exact values). Table 2shows
pre-test scores of the 11 scales. There was no significant dif-
ference between the experimental group and control group in
any of the scales.
After the intervention, all outcomes showed statistically
significant mean differences between the experimental and
control group (see Table 3). These differences persisted
1 month following intervention completion for all the mea-
sures except the GSE (Self-Efficacy). Statistically significant
group × time interactions within the RM ANOVAS were
found in all outcomes except for the APWB (Autonomy),
GSE (Self-Efficacy), and COS (Compassion for others) with
low to moderate effect sizes. With regard to the slope of well-
being, the gains of the experimental group remained constant
on the PHI-EW (Experienced well-being) subscale 1 month
after the intervention, as illustrated in Fig. 2. The operations
carried out in an Bintent to treat^fashion (i.e. with imputed
data) showed differences in the Bper protocol^analyses of
only 13 of the total 55 scenarios. Diverging results were no-
ticed in one of the five imputations for the PHI (Well-being,
with no interaction found), five for the GQ6 (Gratitude, idem),
one for the SCS (Self-compassion, idem), one for the MLQ-P
Fig. 2 Evolution of the Pamberton Happiness Index (PHI) in the experimental group using per protocol (PP, available data, left) and intent to treat (ITT,
imputed, right) approaches
Mindfulness

(Meaning in life, with no interaction found), two for the COS
(Compassion for others, with interaction) and three for the
APM (Appreciation, with interaction found).
Participants had been meditating for an average of
2.69 years, spent an average of 17.14 min meditating per
day during the intervention, and the mean practice during
the study was 39 days with a similar amount of average com-
pleted meditations. After controlling for these four variables
(previous meditation experience, baseline weekly meditation
hours, meditation frequency and practice over the study peri-
od), no difference was found in the RM ANCOVA results and
the split-plot ANOVAS, with just the condition as factor. The
duration of the participants’previous meditation experience
did statistically significantly co-variate with the slope of stress
(PSS; F=3.254, p<.05, ηp
2
= .056) and mindfulness (FMI;
F= 3.640, p< .05, ηp
2
= .047) and the weekly hours medi-
tating co-variated with autonomy (APWB; F=3.771,
p<.05, ηp
2
= .081). The frequency of completed meditation
and daily practice significantly co-variated (very strongly)
with the slope of appreciation (APM; meditations:
F= 21.282, p< .0001, ηp
2
= .492, practices: F= 12.294,
p<.0001,ηp
2
=.358).
Further, RM ANCOVAS revealed that BDI-II and PHI
scores co-variated significantly with scores such as the PSS
Tabl e 2 Comparison of
demographic characteristics and
baseline psychometric measures
between control and experimental
groups
Socio-demographics Experimental (n= 212) Control (n= 182) Statistical significance
N%N%
Gender (% female) 163 76.9 147 80.8 χ
2
=.880, p= .348
Education (University degree) 164 77.4 140 76.9 χ
2
=.011,p=.918
Income (below household income
over $35,000 a year)
105 49.5 95 52.2 χ
2
=.279, p= .597
MSDMSD
Age 41.31 11.51 40.32 11.08 t=.864,p= .388
Meditation experience in years 2.80 3.04 2.58 2.77 t=.751,p= .453
Wel l -be ing
Stress (PSS) 28.54 6.82 28.38 6.18 t=.242,p= .809
Depression (BDI-II) 13.46 9.48 12.55 8.58 t=.982,p= .327
Well-being (PHI-PIS) 6.44 1.74 6.36 1.76 t=.435,p= .664
Mindfulness (FMI) 33.08 7.71 34.23 8.26 t=−1.428, p= .154
Gratitude (GQ6) 35.15 5.85 35.04 5.59 t=.181,p= .856
Self-compassion (SCS) 3.02 0.73 3.05 0.80 t=−.358, p= .720
Self-efficacy (GSE) 30.65 4.50 30.58 4.39 t=.844,p= .399
Autonomy (APWB) 57.98 12.08 56.91 12.56 t=.319,p= .750
Meaning (MLQP) 23.70 6.92 23.77 7.22 t=−.096, p= .924
Positive relations (COS) 70.48 9.14 71.52 8.75 t=−1.123, p= .262
Engagement (APM) 39.59 7.01 38.99 7.97 t=.765, p= .445
Tabl e 3 Measurement results of all scales comparing experimental and control groups
Post-test 1 month post-test Group × time interactions
Experimental
(n=53)
Control
(n= 115)
Mean difference
statistical significance
Experimental
(n=35)
Control
(n=43)
Mean difference
statistical
significance
(Greenhouse-Geisser
interaction of outcomes
with group)
MSDMSDtdfp MSDMSD tdfp Fdfp ηp
2
PSS 22.45 5.45 26.92 7.31 −4.39 132.7 <.0001 19.35 5.66 25.15 6.46 6.46 −3.63 58.0 <.001 8.62 1.8 <.001 .110
BDI-II 4.72 5.38 11.36 10.18 −5.52 162.9 <.0001 3.50 3.44 11.70 8.77 8.77 −5.24 54.3 <.0001 8.62 1.8 <.001 .110
PHI 7.81 1.23 6.66 1.94 4.65 149.4 <.0001 8.28 1.38 6.76 1.77 1.77 4.26 75.9 <.0001 10.62 1.8 <.0001 .124
FMI 40.96 7.32 36.09 8.77 3.52 166.0 <.001 43.49 6.30 37.30 8.16 8.16 3.68 76.0 <.0001 16.22 1.8 <.0001 .176
GQ6 38.54 4.15 35.01 6.53 4.04 140.1 <.0001 39.96 3.22 35.35 6.01 6.01 3.81 52.6 <.0001 5.24 2 <.005 .083
SCS 3.64 0.74 3.16 0.87 3.52 110.1 <.001 4.00 0.70 3.43 0.81 0.81 2.86 58.0 .006 11.24 1.6 <.0001 .165
GSE 33.66 3.63 31.64 5.12 2.50 150.0 .013 36.31 3.69 34.82 5.52 5.52 1.25 57.1 .218 1.03 1.5 .343 .018
APWB 64.76 10.35 58.58 13.27 3.14 121.6 .002 62.67 13.02 53.38 10.45 10.45 2.56 30.3 .016 2.78 1.9 .071 .058
MLQP 29.32 4.70 23.73 8.23 5.32 146.5 <.0001 29.84 5.41 25.15 6.72 6.72 2.86 56.0 .006 5.38 1.8 <.01 .088
COS 75.19 7.09 70.66 10.28 3.17 133.4 .002 76.09 8.49 69.78 9.17 9.17 2.68 56.0 .010 2.38 1.9 .1 .041
APM 45.40 4.22 39.72 8.75 5.40 150.0 <.0001 46.00 4.64 41.91 6.03 6.03 2.80 55.0 .007 3.49 1.7 <.05 .060
Mindfulness

(BDI; F= 4.993, p<.05, ηp
2
= .083), FMI (BDI; F= 4.575,
p<.05, ηp
2
= .058), APWB (BDI; F= 5.236, p<.01,
ηp
2
= .109), MLQ-P (BDI; F= 10.275, p< .0001, ηp
2
= .160),
and APM (BDI; F= 4.408, p<.05,ηp
2
= .077). No statistically
significant co-variation was found for the PHI baseline scores.
Discussion
The present study has yielded important findings, indicating
that the PMP was able to boost well-being which paves the
way for future research in this area. The study demonstrates
the efficacy of this new type of intervention by confirming the
two hypotheses made at its outset. Participation in the PMP
led to statistically significantly higher post-test results on all
the scales in the experimental group, compared with the con-
trol group. More specifically, participants exhibited increases
in nine measures (positive emotions, self-compassion, happi-
ness, autonomy, mindfulness, self-efficacy, meaning, compas-
sion to others and savouring) and decreases in the other two
(stress and depression). These changes were still found with
participants who completed the intervention in a 1-month fol-
low-up, in 10 out of the 11 measures. Longitudinal analyses
yielded statistically significant differences in the slope of the
mean evolutions in 8 out of the 11 measures, confirming the
longitudinal impact.
The PMP was also found to be feasible with participants
with mild levels of depression, constituting the baseline level
of the latter a co-variate of the improvement in various param-
eters. These results further substantiated previous findings that
indicated the existence of a link between mindfulness and
positive variables. The results evidenced the capacity of
mindfulness-based programs to significantly promote positive
change. They also suggested that PMP could complement the
currently used deficit-focused programs and could be used as
an alternative method of studying the way mindfulness could
lead to greater well-being.
The structure of the PMP has proven effective; a daily
practice interweaving PPIs and mindfulness has shown an
ability to produce the desired effect. The positive mindfulness
cycle could be a promising theoretical framework for the point
of convergence between the two disciplines of PP and mind-
fulness. The IAA model of mindfulness (Shapiro et al. 2006)
and the experience of savouring (Bryant and Veroff 2007)
were used to integrate the PMP components, and to explain
the program’s mechanism. The PPIs intentions set the stage
for mindfulness, which, in turn, allowed boosted savouring of
the PPIs, thus creating a cyclic process enhancing well-being.
The results of this study supported the idea that, once strengths
and virtues are set as the intention of the practice and are
followed by mindfulness and savouring, an increase can be
achieved in a variety of well-being variables.
The results also showed that in 10 of the 11 measures, the
improvement persisted 1 month after the program’scomple-
tion. This indicated that the impact of the program does not
fade away with the end of practice, allowing participants to
benefit from a ripple effect of enhanced well-being for at least
a month following the program. Longitudinal studies are
scarce and much needed in positive psychology research
(Avey et al. 2008). The results of the present study with their
variety of enhanced well-being variables are a valuable con-
tribution to the positive psychology literature.
The effectiveness of the PMP is further exemplified by the
weekly increase in well-being noticed in the experimental
group, as seen in the constant gains on the PHI-EW
(Experienced well-being) Subscale. These gains persisted a
month after the intervention’s completion and were shown
for imputed data (which could be considered a more conser-
vative approach) as well. Significant interactions were also
found between most of the outcomes, with the exception of
Autonomy, Self-Efficacy, and Compassion for others and in
all of the imputed versions ofthe Gratitude scale. These results
indicated a lasting effect in most variables; the effect was not
transient, and the evolution of improvement continuously
increased.
The potential of the PMP is particularly striking considering
that the program is well suited for replication on a larger scale.
Because it is delivered online, the program may be scaled up to
include large populations worldwide. It is inexpensive to deliv-
er and requires dedicating no more than 12 min a day. Online
delivery also means that the program does not require a trained
facilitator and could be delivered to people in the familiar set-
tings of their own homes (Krusche et al. 2012).
Delivering the PMP to large and varied populations is of
particular importance, given that one of the most impressive
improvements introduced by the program was in the levels of
depression. Baseline levels of depression co-variated signifi-
cantly with the measures of Perceived Stress, Mindfulness,
Autonomy, Meaning and Present Moment Appreciation, par-
tially confirming the secondary hypothesis. These results are
in line with the meta-analysis conducted by Sin and
Lyubomirsky (2009), which examined 25 separate studies
on the influence of PPIs on depression. According to the find-
ings of the meta-analysis, depressed participants gained more
from the PPIs than non-depressed participants did. The con-
clusions of the present study support the idea (Fava et al.
2005) that PP may also be suitable for individuals with psy-
chological difficulties. The PMP could assist in dealing with
depression by shifting people from Blanguishing^towards
Bflourishing^on the mental health continuum (Keyes 2002).
Online inexpensive programs such as the PMP are able to
assist over-burdened health care systems (Krusche et al.
2012), where people go untreated due to the high cost of other
interventions (Layous et al. 2011). Future research could test
the specific efficacy of the PMP in depressed individuals.
Mindfulness

The PMP was developed to complement existing mindful-
ness programs, and it would be interesting to make a
comparison between them. Grossman et al. (2004) conducted
a meta-analysis of randomised controlled trials of MBSR pro-
grams which revealed effect sizes for wait-list studies similar
to the present one of d= 0.49, 0.67, 0.62 and 0.54 (r=0.24,
0.32, 0.3 and 0.26, respectively), including the measures of
mental health and psychological well-being. In relation to dif-
ferences in the evolution of control and intervention groups,
the PMP effect size was r=.35 (ηp
2
= 0.124) for well-being
on the PHI. A randomised control trial would be useful to
thoroughly compare the PMP with existing mindfulness
programs. This is a potential future research direction.
One possible PMP advantage worth exploring is its ability
to offer support without pathologisation, much like other
PPIs, reducing stigma and thus being more appealing to
the general population.
Another direction for future research could be explor-
ing the underlying mechanisms of PMP-induced positive
change. The results of the present study indicate that the
number of times the participants completed the medita-
tions and the daily practices had little effect on their
gains. The frequency of practice only co-variated with
the APM. This result is different from those of other stud-
ies, where extended practice increased the effects of mind-
fulness interventions (e.g. Carmody and Baer 2008). This
raised questions about the way the program worked. We
tended to assume that in the present study, informal prac-
tice had a greater impact than formal practice. The videos,
meditations and daily practice that were part of the inter-
vention protocol instructed the participants to apply the
knowledge and skills they acquired to their everyday life.
The implementation of the intervention materials in the
participant’s daily interactions and events may have had
a greater influence than the daily Bformal^meditation and
subsequent practice. This seems even more probable if we
consider that the participants were told not to advance to
the materials of the next week until they had engaged at
least once with the video, meditation and practice of that
week and applied them within a 7-day framework.
It is recommended to incorporate a measure of informal
practice in future studies, in which the participants will be
asked to report at the end of every day how many times they
applied the intervention’s practice in their experiences of that
day. A qualitative research element may also be added to
future studies, to assist in deeper understanding of the partic-
ipants’experiences and the mechanisms behind the interven-
tion’ssuccess.
Online mindfulness programs have proven effective
(Krusche et al. 2012). The need for online mindfulness pro-
grams stems from patients’requirement for a flexible delivery
method and mental health systems which are under heavy
pressure to deliver more for less (Kuyken 2011). Therefore,
online mindfulness programs would benefit a large number of
people, who otherwise could not have joined such courses
(Beattie et al. 2009). These courses have delivered promising
results, proving to be of great benefit to patients with a range
of disorders (Hollandare et al. 2011). At the same time, deliv-
ering the PMP in person could prove a valuable avenue of
investigation as in-person delivery may reduce attrition rates.
It would also help provide psychological support during the
intervention that would be particularly valuable in studying
the effect of the PMP on depressed populations.
Limitations
Several limitations of the PMP must be acknowledged. First,
although the groups were equal in size at the outset of the
program, because of the high attrition rate, the control group
(N= 115) was considerably larger than the experimental group
(N= 53) upon completion. This point could be addressed by
closer monitoring and implementing measures to increase mo-
tivation in the control group. At the applied level, without the
limitations and rigidity required for a randomised controlled
trial, meditation would be practiced with a more flexible sche-
ma where people can practise with varying degrees of inten-
sity. Another apparent limitation is the program’s complete
reliance on self-report scales, which are vulnerable to social
desirability response bias. While it is unlikely that this ac-
counts for all significant results, this latent risk could be over-
come by conducting future studies with active controls or with
objective measures such as physical health or behaviour.
External validity was strong as participants received the pro-
gram online in much the same way it would be delivered to a
general population audience. The participating population was
mixed in terms of age, income and location, which enhances
generalisability. However, the participants were predominant-
ly highly educated females, and although they came from the
twentieth country, the majority were from English-speaking
Western cultures. Further studies with different populations
could yield more inclusive results. Treatment expectancy
could not be ruled out, as no specific scale was added to the
baseline measures package. However, the inclusion of a group
of people practising meditation gave us an idea of the differ-
ential effect of the PMP on people with previous experience.
Finally, the current study did not evaluate whether participants
had a current meditation or yoga practice, which could have
been an influencing factor. Future studies should address this
issue and examine the impact of this potential variable.
A concern to be tackled is that the positive mindfulness
cycle might generate an attachment to pleasant or positive
experiences, leading to potential suffering when the expe-
rience unavoidably disappears (Garland et al. 2015).
Addressing this concern, Wallace and Shapiro (2006)state:
BA common misperception is that Buddhism uniformly de-
nies the value of stimulus-driven pleasures, as if it were
Mindfulness

morally wrong to enjoy the simple pleasures of life,
let alone the joys of raising a family, creating fine works
of art, or making scientific discoveries…The enjoyment of
such transient experiences is not in opposition to the culti-
vation of positive attitudes and commitments or the culti-
vation of the types of mental balance that yield inner well-
being^(p. 692). Mindfulness practice allows the cultivation
of a non-attached, open relationship with experiences,
thereby strengthening the practitioner’s capacity to let go
of any potential attachment as part of the positive mindful-
ness cycle. Mindfulness practice does not happen in a vac-
uum; therefore, having intentions or savouring experiences
is a natural part of the practice. According to Carlson
(2015), this is not a concern, as long as the intentions and
savouring are accompanied and balanced by equanimity
and non-attachment. In fact, Carlson (2015)believesthat
the awareness of impermanence infuses beauty and non-
attached joy in savouring and intentions because the prac-
titioner knows that they will fade away and change.
Compliance with Ethical Standards
Conflict of Interest The authors declare that they have no conflict of
interest.
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