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What defines mindfulness-based programs? The warp and the weft



There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementation of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sustainable development of the field there is a need to articulate a definition of what an MBP is and what it is not. This paper provides a framework to define the essential characteristics of the family of MBPs originating from the parent program MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education; underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding. The paper's aim is to support clarity, which will in turn support the systematic development of MBP research, and the integrity of the field during the process of implementation in the mainstream.
What denes mindfulness-based programs? The
warp and the weft
R. S. Crane
*, J. Brewer
, C. Feldman
, J. Kabat-Zinn
, S. Santorelli
, J. M. G. Williams
W. Kuyken
Centre for Mindfulness Research and Practice, School of Psychology, Bangor University, Brigantia Building, Gwynedd, UK
Department of Medicine, Center for Mindfulness in Medicine, Health Care, and Society, University of Massachusetts Medical School, Worcester,
Yale University School of Medicine
Freelance Teacher and Writer, Totnes, Devon, UK
Oxford Mindfulness Centre, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress
Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementa-
tion of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sus-
tainable development of the eld there is a need to articulate a denition of what an MBP is and what it is not. This
paper provides a framework to dene the essential characteristics of the family of MBPs originating from the parent pro-
gram MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework
addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that
draw from a conuence of contemplative traditions, science, and the major disciplines of medicine, psychology and edu-
cation; underpinned by a model of human experience which addresses the causes of human distress and the pathways to
relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an
approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater
attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mind-
fulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding.
The papers aim is to support clarity, which will in turn support the systematic development of MBP research, and the
integrity of the eld during the process of implementation in the mainstream.
Received 7 June 2016; Revised 23 November 2016; Accepted 23 November 2016
Key words: Fidelity, mindfulness-based cognitive therapy, mindfulness-based program, mindfulness-based stress
There has been an explosion of interest in mindfulness-
based programs (MBPs) such as Mindfulness-Based
Stress Reduction (MBSR) and Mindfulness-Based
Cognitive Therapy (MBCT) in the last two decades.
MBSR has accrued a robust evidence base in improv-
ing mental health outcomes in those with chronic
physical health problems (Bohlmeijer et al. 2010).
MBCT is an adaptation developed to teach those at
high risk of depressive relapse skills to stay well and
has been shown to be effective (Kuyken et al. 2016).
There are multiple other MBPs with varying levels of
research evidence at each stage of the research journey
(Dimidjian & Segal, 2015).
For the sustainable development of the eld there is
a need to pause and address some fundamental ques-
tions. Dimidjian & Segal (2015) analyzed the status of
the extant evidence using the National Institutes of
Health (NIH) Stage Model (Onken et al. 2014). This is
a model of behavioral intervention development com-
posed of six stages: basic science (Stage 0); intervention
generation, renement, modication, and adaptation
and pilot testing (Stage I); traditional efcacy testing
(Stage II); efcacy testing with real-world providers
(Stage III); effectiveness research (Stage IV) and; dis-
semination and implementation research (Stage V).
The mapping of the MBP evidence base onto this
model by Dimidjian & Segal claries that the evidence
is heavily saturated in Stage I, lightly represented in
Stages 0 and II, and that to date there is minimal
research in Stages III, IV and V. Overall, in their ana-
lysis they identify signicant strengths (e.g. breadth
of clinical problems and populations targeted), and
signicant weaknesses (e.g. the need for an integrated
* Address for correspondence: R. S. Crane, Ph.D., M.A., Centre for
Mindfulness Research and Practice, School of Psychology, Bangor
University, Brigantia Building, Gwynedd LL57 2AS, UK.
Psychological Medicine, Page 1 of 10. © Cambridge University Press 2016
doi:10.1017/S0033291716003317 EDITORIAL
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and systematic approach to core research questions
across all stages of the research from basic through to
implementation science). In this editorial we focus on
a critical underpinning issue throughout the Stage
Model namely the delity/integrity of the interven-
tion itself. Fidelity is central to all stages but has par-
ticular salience at Stages I and V. Stage I involves the
development of the intervention, which requires great
clarity about for whom it is intended, and a theoretical
exposition of what mechanisms are being targeted. It
also requires careful consideration of what clinician
training and supervision is required to deliver the
intervention effectively. Stage V addresses implemen-
tation, which raises similar issues about what key
aspects of delity need to be maintained when imple-
menting in real world settings.
Given the proliferation of MBP development and
research, there is a need to re-clarify the core ingredi-
ents of mindfulness-based programs, and the implica-
tions this has for professional training, supervision
and implementation. This clarity is important for the
eld so that existing research can be meaningfully
interpreted, future research uses agreed denitions
and established protocols, MBP teachers are trained
appropriately, and the general public are assured that
programs titles accurately describe what is delivered.
MBPs in context
MBSR was developed as an education and training
vehicle for people with chronic health problems and
those suffering from the mounting demands associated
with psychological and emotional stress, to learn to
relate in new ways to life challenges (Kabat-Zinn,
2013). Other programs based upon the foundational
approach and structure of MBSR have since been devel-
oped with particular aims across a broad range of set-
tings, including hospitals, schools and prisons, and are
gaining interest from policy makers (Ryan, 2013;
Mindfulness All Party Parliamentary Group, 2015).
MBP developments are nested within a wider context
of empirical developments within psychology, medicine,
health care and education which include mindful-
ness-informedprograms such as Acceptance and
Commitment Therapy (Hayes et al. 2011), Compassion
Focused Therapy (Gilbert, 2009), Dialectical Behavioral
Therapy (Linehan, 1993), Mindful Self Compassion
(Neff & Germer, 2013) and developments in the eld of
Positive Psychology (Seligman & Csikszentmihalyi,
2000). These mindfulness-informed developments are
part of the third wave of empirically tested psychothera-
pies (rst wave being behavioral therapy; second wave
being cognitive behavioral therapy). Third wave
approaches have a decreased emphasis on controlling
internal experience, and an increased emphasis on
themes such as acceptance, metacognition and how peo-
ple relate to their experiences.Mindfulness-informed pro-
grams share several underpinning theoretical ideas with
MBPs, and many include some mindfulness meditation
practice in their approach. However, a distinctive feature
of MBPs is that systematic and sustained training in for-
mal and informal mindfulness meditation practices (for
both teacher and participants) is central both to the thera-
peutic approach and underpinning theoretical model.
They are based on mindfulness.
It should also be noted that other MBPs exist alongside
MBSR/MBCT which also share this emphasis on theprac-
tice of mindfulness-meditation as a central pedagogical
component. An important example are second gener-
ationmindfulness-based interventions which are openly
spiritual in nature, make the linkage to the Buddhist
teachingsexplicit withinthe pedagogy and aremore trad-
itional in the manner in which they construct and teach
mindfulness (e.g. VanGordon et al. 2015).These programs
are at an earlierstage of development and research is now
underway. However, the boundary to the analysis in this
paper are what have retrospectively become termed
rst-generationMBPs i.e. MBSR and MBCT (which
represent the strongest evidence within the eld), and
the range of programs which have developed out of
these (e.g. Bowen et al. 2009; Duncan & Bardacke, 2010;
Kristeller et al. 2012). These rst-generation MBPs, while
drawing aspects of their underpinning models and prac-
tices from aspects of Buddhism, aim to clearly
re-contextualize both the program content and theoretical
underpinnings within the mainstream. That is to say, the
aim is to ensure MBPs are based in science and contem-
porary approaches to managing mental and physical
health and supporting well-being; that they are suitable
for delivery in mainstream public institutions across a
range of settings and cultures; and that they are max-
imally accessible to people with diverse values and reli-
gious afliations.
It is also important to note that while MBPs have
been developed for particular issues such as stress
and depression, there are other empirically supported
approaches for such difculties. There is as yet no com-
pelling evidence for specicity of hypothesized
mechanisms or differential outcomes. This may be an
artifact of the many shared components between
these approaches, or it may simply be that this work
has not yet been done. Our hope is that the clarity
we aim to offer in this editorial will support measure-
ment, mechanisms, and mediators research, as a recent
editorial has argued is needed (Davidson, 2016).
Development trajectory for MBPs
In the context of high interest and rapid proliferation
Dimidjian & Segal (2015) identify several key
2R. S. Crane et al.
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challenges for the next phase of research developments.
This editorial focuses on one of these challenges
research and practice issues in the arena of MBP delity.
If these challenges are not carefully addressed they will
undermine the developing science as well as the quality
and integrity of implementation in routine practice.
Mindfulness training in various forms is rapidly being
applied within different contexts and populations, and
morphing into multiple curriculums of differing lengths
and teaching methods. Mindfulness can be intuitively
appealing to teachers and participants. There is conse-
quently a grassroots spread of practice into populations
and contexts, which at times is ahead of the evidence.
The word mindfulness has become a word conveying
a multitude of meanings and practices. This is a confus-
ing context within which to systematically build the sci-
ence and the practice integrity of MBPs.
The essential and variable elements of
rst-generation MBPs
We use the metaphor of warp and weftto represent
the fabricof MBPs. In weaving, the warp is the
term for the xed thread that runs vertically through
the cloth, while the weft is the term for the transverse
thread that makes each tapestry unique. The warp is
the thread that is xed when the loom is set up,
while the weft varies in texture and color. The essen-
tial, constant and integral threads that dene an MBP
regardless of population or context make up the
warp; they are what make it a mindfulness-based pro-
gram. Each adapted MBP then introduces a unique
weftthat seeks to target the training to a particular
population and/or context. Within each aspect (pro-
gram and teacher) we examine what is warp (i.e. essen-
tial to an MBP), and what is weft (i.e. will vary
depending on context and/or population) (Table 1).
The warp elements of the framework are anchored
within the program forms of MBSR and MBCT. We
suggest that the framework we offer can provide
some unifying clarity for the wider MBP eld on
what an MBP is and is not.
The essential (warp) elements of MBPs
(1) Is informed by theories and practices that draw from a
conuence of contemplative traditions, science, and the
major disciplines of medicine, psychology and education
The key inuences that have shaped MBPs are:
Contemplative mindfulness practices. MBPs are under-
pinned by theories about the human mind-body drawn
from aspects of early Buddhist psychology, which articu-
late the ways in which people can come to recognize uni-
versal habitual psychological patterns that create and
maintain distress. This philosophy and psychology is
nuanced and complex. It includes a wide array of teach-
ings and practices found across the breadth of both
Buddhist and other traditions, which are beyond the
scope of this paper (Williams & Kabat-Zinn, 2013).
However, there is high level consensus on common fea-
tures found within the cultivation of mindfulness. These
include that people can learn that habitual reactive pat-
terns stem from unhelpful habits of the mind; that fear,
denial and discrepancy-based thinking create and
exacerbate distress; and that skillful ways of relating to
experience can be developed through awareness, wise
discernment and practice which offer the potential for
(moments of) freedom from reactivity (Gethin, 1998).
MBPs address some universal features of human
experience using mindfulness practices as a vehicle
for a systematic training of the mind in the service of
developing greater awareness of self and others, and
thus, greater understanding. It is therefore not surpris-
ing that mindfulness practices can be found in many of
the worlds contemplative wisdom traditions. MBPs
draw on aspects of these traditions while leaving
behind their religious, esoteric and mystical elements.
Crucially they are presented in an invitational way,
asking people to use the mindfulness practices in
whatever way best supports their aims and aspirations.
The practices and frameworks employed within MBPs
are thus re-contextualized for implementation within
mainstream settings by ensuring that they are deliv-
ered in inclusive and culturally appropriate ways.
Science. The development of MBPs is grounded in
developments in theory, cognitive neuroscience (Tang
et al. 2015), translational research (Strauman &
Merrill, 2004; Meadows et al. 2014) and evidence-based
practice across a range of disciplines. Empirical evi-
dence informs the theoretical models underpinning
MBPs aims and innovations, and continues to rene
understanding of what works best, at what time, for
which group of participants (Davidson, 2016).
Medicine. MBSR, theoriginal MBP, wasdeveloped within
a medical framework and culture, as a form of partici-
patory medicine in which patients are challenged to dis-
cover and draw upon their own resources for learning,
healing, and transformation (KabatZinn, 2003).
Psychology. MBPs were introduced and incorporated
into the eld of psychology through the development
of MBCT (Segal et al. 2013). Psychological theory and
research now guides the development of many MBPs
(Dimidjian & Segal, 2015). Indeed, the eld of cognitive
What denes mindfulness-based programs? 3
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science has to a large extent taken over the detailed
work of investigating the precise mechanisms by
which MBPs alleviate distress and enable ourishing.
The process involves mapping theories and empirical
understanding across a range of disciplines.
Education. The pedagogical processes employed in
MBPs draw on educational principles that are experi-
ential, interactive, participatory, student-centred and
relationship-centred (Santorelli, 2000).
(2) Is underpinned by a model of human experience which
addresses the causes of human distress and the pathways
to relieving it
The conuence described in the previous section is
supported by a model of distress that applies across
MBPs that explains certain facets of how human dis-
tress is created and maintained, and how mindfulness
training deals with these maintaining factors, and thus
alleviates distress and supports mental health and
well-being e.g. (Kabat-Zinn, 2013; Segal et al. 2013). It
draws on aspects of cognitive science (e.g. attention
and executive control and decentering Barnard &
Teasdale, 1991) and trans-diagnostic work (e.g. repeti-
tive thought and experiential avoidance Dudley et al.
2011). This emerging model is being claried and
developed as empirical understanding is built
(Brewer et al. 2013; Chiesa et al. 2013;Guet al. 2015;
Van der Velden et al. 2015). The eld is young and
emergent, and the underpinning frameworks are the
subject of debate and empirical investigation.
(3) Develops a new relationship with experience character-
ized by present moment focus, decentering, and an
approach orientation
An underpinning premise of the MBP model is the
understanding that how people relate and respond to
various forms of distress (rather than the distress itself)
lies at the core of many problems and disorders. It is
this that determines both the capacity and the extent
to which distress can be relieved and transformed.
The training aims to enable participants to recognize
habitual, conditioned modes of reacting and make a
radical shift in their relationship to their thoughts,
Table 1. The essential (warp) and exible (weft) ingredients of MBPs
Warp Weft
1. Is informed by theories and practices that draw from a
conuence of contemplative traditions, science, and the
major disciplines of medicine, psychology and education
1. The core essential curriculum elements are integrated with
adapted curriculum elements, and tailored to specic contexts
and populations
2. Is underpinned by a model of human experience which
addresses the causes of human distress and the pathways to
relieving it
2. Variations in program structure, length and delivery are
formatted to t the population and context
3. Develops a new relationship with experience characterized
by present moment focus, decentering and an approach
4. Supports the development of greater attentional, emotional
and behavioral self-regulation, as well as positive qualities
such as compassion, wisdom, equanimity.
5. Engages the participant in a sustained intensive training in
mindfulness meditation practice, in an experiential
inquiry-based learning process and in exercises to develop
insight and understanding
MBP teacher
1. Has particular competencies which enable the effective
delivery of the MBP
1. Has knowledge, experience and professional training related
to the specialist populations that the mindfulness-based
course will be delivered to
2. Has the capacity to embody the qualities and attitudes of
mindfulness within the process of the teaching
2. Has knowledge of relevant underlying theoretical processes
which underpin the teaching for particular contexts or
3. Has engaged in appropriate training and commits to
ongoing good practice
4. Is part of a participatory learning process with their students,
clients or patients
4R. S. Crane et al.
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feelings and body sensations, as well as to outer cir-
cumstances. The shift in relationship is based on
what is called decentering (Segal et al. 2013)or
re-perceiving (Shapiro et al. 2006), in which the MBP
participant is trained to attend to thoughts and feelings
as mental events by noticing how they come and go in
the mind and how each has consequences in the very
next moment. For example, a person who is rushing
to a meeting, might come to realize that in addition
to the stress of being late they are compounding the
stress by the thought if Im late everybody will think
I am not coping. Whereas in an approach such as cog-
nitive therapy, a person might be taught to challenge
such a thought, in MBPs the emphasis is on seeing it
as a mental event, noticing its effects on the body,
and the way it creates further feelings and thoughts
that were not part of the original situation. Gradually
people come to see that their thoughts are not necessar-
ily valid representations of reality.
(4) Supports the development of greater attentional, emo-
tional and behavioral self-regulation, as well as positive
qualities such as compassion, wisdom, equanimity
Attentional training within MBPs offers a founda-
tion for the attitudinal dimensions of mindfulness to
emerge. MBPs seek to support the ability to meet
experience with curiosity, equanimity and compassion
(Feldman & Kuyken, 2011). An experiential under-
standing develops that pain is an inherent part of
human experience and is ever changing. An orienta-
tion of mind characterized by curiosity, patience and
equanimity supports the development of compassion
and wisdom. There is an intention to cultivate an
internal climate of friendliness towards experience
whether it be pleasant or unpleasant. This supports a
shift away from habitually battling with experience.
MBPs also aim to cultivate positive qualities such as
joy, and the ability to recognize and savour nourishing
and pleasant experiences.
(5) Engages the participant in a sustained intensive train-
ing in mindfulness meditation practice, in an experien-
tial inquiry-based learning process, and in exercises to
develop insight and understanding
Direct experiential, systematic and intensive engage-
ment in formal and informal mindfulness meditation
practices is foundational to teaching/learning in
MBPs. The training develops familiarity with and
understanding of the mind and body, and appreciation
that attention can be regulated, ne-tuned, and opti-
mized through training. Rather like physical training
regimes, the training progresses developmentally and
sequentially throughout the program.
The integrity and delity of each MBP is maintained
by ensuring that all the curriculum elements for the
particular program are included as intended (adher-
ence) and that curriculum elements are not added
which do not belong to the particular program form
(differentiation) (Crane et al. 2013). It is critical that
the curriculum employed and the particular MBP title
match each other. If there is divergence from an estab-
lished curriculum, teaching structure or process then a
new title for the adaptation should be employed, and
research should clearly identify the adapted curriculum
guide used, and if any checks on delity and adherence
were employed.
Adherence to program form is supported by proto-
cols for each MBP (e.g. see Santorelli et al. 2017 and
Stahl & Goldstein, 2010, for MBSR curriculum guides,
and Segal et al. 2013, for the MBCT curriculum guide).
Other MBPs have published guides which specify their
particular curriculum adaptations. MBP curriculums
vary in terms of number and duration of sessions
and time commitments for home practice. For example,
MBSR is scheduled over eight weekly sessions lasting
2.5 h with 40 min of guided mindfulness meditation
home practice per day. MBCT is the same but with
2 h long sessions. There is not scope to fully list the cur-
riculum elements and therapeutic techniques which, if
included, would be regarded as outside the model for
a particular rst generation MBP (the differentiation
aspect of program integrity). However, examples
include: thought challenging and collecting evidence
for and against the truth for thoughts (which is part
of cognitive therapy); an orientation of problem solv-
ing or xing; different sorts of meditation practices
(e.g. mantra meditation); talking about the detailed
history of participants; and an emphasis on relaxation
MBPs typically include mindfulness training via
three formal mindfulness meditation practices the
body scan, mindful movement and sitting meditation.
Practices are assigned as daily home practice with the
support of recorded guidance. Throughout the pro-
gram participants are also encouraged to generalize
through informal practice by bringing awareness in
particular ways to everyday activities.
MBPs include learning experiences built around the
formal mindfulness meditation training. These include
engaging in an individual and collective investigative
inquiry to develop skills in recognizing direct experi-
ences (i.e. thoughts, emotions and sensations), patterns
of relating to experience, and the wider implications of
the understandings that emerge. This externalized
teacher- led interactional process in class becomes a
representation of the work that the MBP participants
begin to engage in within themselves, whereby the
investigative process becomes internalized. Foci for
inquiry include participantsdirect experience of medi-
tation practices, and exploration of pleasant and
What denes mindfulness-based programs? 5
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unpleasant experiences which has implications for rec-
ognizing established patterns of reactivity and the pos-
sibility of responding differently. The focus will
depend on the context/population, but MBPs particu-
larly investigate the territory of difcult, unwanted
experiences stress, depression, physical pain, etc.
Participants are invited to explore How am I experien-
cing and relating to these difculties physically, emo-
tionally and psychologically? What possibilities are
there for stepping out of habitual aversive reactive pat-
terns into responding with greater awareness and
agency?Each MBP employs particular exercises to
facilitate these investigations.
The teacher
(1) Has particular competencies which enable the effective
delivery of the MBP
MBP teachers have particular explicitor visibleteaching
competencies. These competencies are described and can
be assessed using the Mindfulness-Based Interventions:
Teaching Assessment Criteria (MBI:TAC), which has
shown promising evidence as a reliable and valid tool
(Crane et al. 2012,2013,2016). The six teaching competence
domains within the MBI:TAC are coverage, pacing and
organization of the session curriculum; specicinterper-
sonal relational skills; skilful guiding of formal mindful-
ness meditation practices; specic methodologies for
conveying the course themes through interactive inquiry,
group dialog and didactic teaching; and effective holding
of the group teaching/learning environment. These require
particular tailored training experiences to develop (Crane
et al. 2010).
(2) Has the capacity to embody the qualities and attitudes of
mindfulness within the process of the teaching
MBP teachers have in common a sustained commit-
ment to cultivating mindfulness through regular daily
formal and informal mindfulness practices in everyday
life. The way in which mindfulness practice manifests
in the life of the teacher and is tangibly sensed in the
MBP classroom is termed embodiment. The theoret-
ical model hypothesizing how MBP training has its
effects includes embodiment as a critical factor in enab-
ling participants to move towards experiential (rather
than conceptual) knowing of mindfulness (Teasdale
et al. 2002). Embodiment is a natural outcome of the
teachers intention to mindfully inhabit their experi-
ence in everyday life and in the MBP classroom, to
whatever degree possible in any given moment. It is
neither a striving for a particular state, nor a contriv-
ance to articially fabricate a particular persona,
mask or appearance. Through their own personal
mindfulness practice, teachers naturally come to
inhabit the qualities associated with mindfulness (i.e.
non-striving, non-judging, allowing), and the under-
standings and ethics underpinning the practices. The
embodied practice element of ethics within MBPs are
thus emergent and cultivated through the practice
rather than being mandated. The practice of mindful-
ness enables the participant to try out the possibility
of eliciting kindness, openness, and patience toward
immediate experience, whether the experience is per-
ceived as pleasant, unpleasant, or neutral (Grossman,
2015). MBP teacher training aims to cultivate the cap-
acity in teachers to communicate mindfulness through
the process as much as through the content of the
teaching, by integrating training in formal and infor-
mal mindfulness practices into the other aspects of
the teacher education and training curriculum.
(3) Has engaged in appropriate training and commits to
ongoing good practice
MBP teachers have by necessity engaged in appropri-
ate education and training to build and deepen their
teaching competence (Crane et al. 2010,2012;
Kabat-Zinn et al. 2011;Marxet al. 2015). Training
involves foundational experiential engagement with
mindfulness practice and with the particular MBP cur-
riculum the teacher training is embedded within, prelim-
inary teacher training to build core skills, knowledge
and attitudes, and then further training to enable the
practitioner to reach the threshold of competence.
Within some training programmes, the training journey
culminates in an assessment of teaching competence
using the MBI:TAC (Crane et al. 2016), conducted by trai-
ners who have been trained to reliably use the tool.
Teachers then commit to ongoing good professional
practice in line with consensually agreed good
practice standards and guidelines (UK Network for
Mindfulness-Based Teacher Training Organisations,
2012; Santorelli, 2014). Two key elements of good prac-
tice are supervision (Evans et al. 2014), and ongoing
engagement with a personal mindfulness practice
including periodic periods of intensive mindfulness
practice in a residential setting. As the work of rst
generation MBPs is becoming more established in the
mainstream, more opportunities are opening up for
residential mindfulness intensives within a thoroughly
mainstream context (e.g. Mindfulness Network CIC,
In the UK there is a national listing of MBP teachers
who have undertaken training to minimum good prac-
tice level, and are adhering to ongoing good practice
(UK Network for Mindfulness-Based Teacher Training
Organisations, 2016). In the USA there is an MBSR
Registry for certied teachers (Centre for Mindfulness
in Medicine Health Care and Society, 2016). The organ-
ization of governance within this emerging eld to
6R. S. Crane et al.
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support the general public to access well prepared and
qualied MBP teachers is underway.
MBP teachers operate within professional ethical
codes anchored within their root profession (i.e. medi-
cine, clinical psychology, teaching, etc.) (Baer, 2015),
and appropriate to the ethos and ethics of the main-
stream public institution within which they are imple-
menting (Crane, 2016).
(4) Is part of a participatory learning process with their stu-
dents, clients or patients
Delivery of MBPs is usually in a group context
which supports perspective taking and the transition
from personal story into investigation of common
pathways which lead to distress. MBP teachers
embed themselves within this investigation. They are
in a particular form of relationship with their partici-
pants which is underpinned by recognition of our
common humanity(shared human experience)
(Neff, 2011), and thus the mutual nature of the learning
process (Santorelli, 2000).
Integration of tailored elements into adapted
mindfulness-meditation based programs
As the eld has developed, new MBPs have woven in a
weft that aims to make the mindfulness framework
and practices more accessible and useful for particular
populations and in varying contexts. However it
remains an empirical question for each new adaptation
whether it improves the accessibility and usefulness of
MBPs, and each adaptation needs to commit to build-
ing its own evidence base.
Adaptations are typically of three kinds:
(1) Adaptations informed by theoretical frameworks or
models that are particular to a new population or
setting. For example, MBCT for recurrent depres-
sion is oriented around a cognitive model of
depressive relapse and how mindfulness can free
the mind from engrained patterns of depressive
rumination (Teasdale & Chaskalson, 2011).
(2) Adaptations to the program that make it more access-
ible, acceptable and potent for a population. For
example, Mindfulness-Based Eating Awareness
Training employs mindful eating practices (Kristeller
& Wolever, 2011); mindful parenting programs use
parenting activities and examples (Bogels et al. 2010).
(3) Adaptations to the program that embed MBPs in
aparticular context or setting.Forexample,MBSR
is an outpatient program that can be offered in
hospital outpatient settings; mindfulness in
schools programs are adapted for delivery within
school curricula (Kuyken et al. 2013); and mind-
fulness in organizations are adapted so as be
accessible to and within businesses (Chaskalson,
We next identify the program and teacher character-
istics that characterize the weft of MBPs, namely the
ways they are adapted (see Table 1).
Adapted MBP considerations
(1) The core essential curriculum elements are integrated
with adapted curriculum elements, and tailored to
specic contexts and populations
It is important that there is explicit clarity regarding
the core intentions of the MBP for the specic context
and targeted participants. MBP developers should
base the development in a clearly articulated aim and
intention regarding the benet and relevance of the
program for a particular context and/or population
(Teasdale et al. 2003; Dobkin et al. 2013). The adapta-
tion needs to be grounded in a theoretically informed
analysis of the specic mechanisms inuencing dis-
tress or life themes in the target population and an ana-
lysis of the contextual issues involved in offering an
MBP in a particular setting (e.g. schools, business, the
military). This analysis is based on an understanding
that general vulnerability (characteristics of the
human condition that predispose us to distress), and
specic vulnerabilities (particular patterns, traits or
tendencies) co-exist (Williams, 2008). Adapted MBPs
are tailored towards recognition of a specic vulner-
ability or life circumstance that characterizes a particu-
lar population (e.g. the easily triggered negative
thinking of people vulnerable to recurrent depression).
How do these issues present themselves? What are
their characteristics? How are they triggered and main-
tained? The MBP developers then need to develop and
seamlessly integrate the adapted weftelements into
the program to ensure that the curriculum skillfully
maps onto these processes. They need to pose the ques-
tion: What are the particular teaching processes and
specic curriculum elements that may be required to
support the mindfulness-based learning experience in
this specic population/context?Program develop-
ment should include recognition of and a skillful
response to any tensions or challenges that need to
be considered in a particular context/population (for
example, participants who may become suicidal
Williams et al. 2015), so that there is an assurance
that there is clearly an added value of the adaptation
over existing MBPs. Dimidjian & Segal (2015) caution
that the rapid proliferation of new potential contexts
and populations risks neglecting the importance of
foundational specication of clear intervention targets
and mediating processes of change on which subse-
quent research can build.
What denes mindfulness-based programs? 7
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(2) Variations in program structure, length and delivery are
formatted to t the population and context
The program form may also be changed to enable
accessibility and tailoring for particular populations
(e.g. shorter, but more sessions for chronic fatigue;
half-day sessions, at fortnightly intervals to enable
working people traveling from a distance to attend;
individual delivery to those who cannot attend a
group), and contexts (e.g. short sessions at lunch time
for workplace mindfulness courses). There is increas-
ing interest in digital delivery methods such as smart-
phone apps (Brewer et al. 2013), and some early
evidence that these and other forms of lower intensity
and self-help programs may be benecial. However,
more research is needed (Cavanagh et al. 2014).
Critically, it is important that new adaptations mak-
ing use of new formats are given appropriate titles to
clearly distinguish them from established programs.
Such careful description and delineation is key to
maintain the health and vitality of the emerging MBP
eld. Without it, the scientic literature will inevitably
conate studies of programs that may not be character-
istic of the core structure, form, dose and delivery
method of a particular MBP but represent themselves
as such, and thus confound our ability to interpret
the emerging scientic exploration of MBPs. It is also
key to ensuring the public are given clear information
on what program they are attending, what training
their MBP teacher has had, and what they are (and
are not) trained to teach.
Teacher considerations for adapted programs
In addition to all the warpelements of training and
ongoing adherence to good practice, teachers who are
teaching particular curriculums, populations, or in par-
ticular contexts need congruent particular trainings. For
example, if the teacher is delivering an MBP in a specic
clinical setting, particular clinical training and experi-
ence in that specic domain is required. Teachers also
need explicit training in the theoretical principles that
underpin the adaptation so that they can effectively con-
vey this essential element in their teaching.
This editorial sets out a framework to dene the essen-
tial (warp) and variant (weft) ingredients of MBPs.
Clarity and precision are needed both to maintain the
integrity of the original programs and to support
ongoing research into new programs, innovations, and
developments. The current dialog between modern sci-
ence and ancient contemplative wisdom traditions
represents an extraordinary conuence of two epistem-
ologies, interacting, learning from and informing one
another. This conuence is proving extraordinarily cre-
ative there is an upsurge of mindfulness-informed and
mindfulness-based programs and approaches across
medicine, psychology, and psychotherapy, and beyond,
into business and education. There are also inherent ten-
sions to navigate in the process of integrating paradig-
matically different disciplines (Harrington & Dunne,
The MBP eld is at an early stage of development.
The evidence supporting their efcacy in the treatment
of physical and psychological health challenges in
some areas is strong and building (e.g. see recent
meta-analyses and reviews Carlson, 2012; Khoury
et al. 2013; Kuyken et al. 2016). However, in many
areas, the landscape can be best characterized as prom-
ising or as yet unexplored. For the eld to realize its
potential to maximally impact individual and societal
health and well-being, there is a continued need for
high quality innovation and research to investigate
mechanisms, effectiveness, and implementation.
Clarity regarding delity to program form and sub-
stance is an essential underpinning to ongoing research
and practice development within this nascent and
highly promising eld.
The paper was written without external funding. We
are grateful to Trish Bartley, Cindy Cooper, Susannah
Crump and Petra Meibert who provided comments
on the manuscript.
Declaration of Interest
R.C., J.K.Z., C.F., S.S., and J.M.G.W. receive royalties
from mindfulness books they have authored. W.K.
is Director of the Oxford Mindfulness Centre and
Principal Investigator of several NIHR and Wellcome
Trust research projects. J.M.G.W., C.F. and J.K.Z. receive
freelance payments for training workshops and presen-
tations related to mindfulness. R.C. is Director of the
Centre for Mindfulness Research and Practice in
Bangor, and a non-salaried Director of a not for prot
company providing services for mindfulness-based tea-
chers. S.S. is Executive Director and Director of the
MBSR Clinic, and J.B. the Director of Research at the
Center for Mindfulness in Medicine, Health Care, and
Society, University of Massachusetts Medical School.
J.K.Z. and J.M.G.W. were previous directors of the
Center for Mindfulness in Medicine, Health Care, and
Society, University of Massachusetts Medical School
and the Oxford Mindfulness Centre respectively. J.K.Z.
receives royalties from mindfulness-based books and
guided meditation programs he has authored, and is
the owner of a web-based outlet for sale of the guided
8R. S. Crane et al.
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meditations. S.F.S. is the Sole Proprietor of Guest-House
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... These two interventions provide complementary skill sets that offer a potentially robust foundation for occupational stress tolerance and primary mental health prevention among service members. Consistent with this integration of the two interventions, some commonly researched mindfulness programs include postural yoga components [11,12], and many postural yoga programs incorporate elements of mindfulness [13,14]. ...
... Third, all soldiers assigned to the intervention condition received both mindfulness training and postural yoga. Given that many mindfulness programs include postural yoga components [11,53] and postural yoga programs often incorporate elements of mindfulness [13,14], mindfulness and yoga might separately contribute to mental health, have a synergistic effect, or have differential impacts on various outcomes. Future research should differentiate between the impacts of mindfulness training and postural yoga on mental health. ...
Full-text available
Background. Depression, anxiety, and sleep problems are prevalent in high-stress occupations including military service. While effective therapies are available, scalable preventive mental health care interventions are needed. This study examined the impact of a combined mindfulness and yoga intervention on the mental health of soldiers in Basic Combat Training (BCT). Methods. U.S. Army soldiers ( N = 1,896 ) were randomized by platoon to an intervention or training-as-usual condition. Soldiers in the intervention condition completed Mindfulness-Based Attention Training (MBAT), engaged in daily 15 min mindfulness practice, and participated in 30 minutes of hatha yoga 6 days per week. Surveys were administered at baseline (T1, prior to training), week 4 of BCT (T2), week 6 (T3), and week 9 (T4). Results. A significant time-by-condition interaction predicting positive screens for depression found that screens decreased at a faster rate from T1 to T4 in the intervention condition (-12.6%) compared to training-as-usual (-7.2%) ( b = − 0.18 , SE = 0.07 , p = 0.028 ). While positive anxiety screens decreased over time across conditions, the time-by-condition interaction found no significant differences in the rate of these decreases by condition ( b = 0.09 , SE = 0.09 , p = 0.273 ). A significant time-by-condition interaction predicting positive screens for sleep problems found that sleep problems decreased in the intervention condition (-1.4%) but increased in training-as-usual (2.0%) ( b = − 0.68 , SE = 0.16 , p = 0.027 ). Conclusion. The mindfulness and yoga intervention was associated with a greater reduction in positive screens for depression and sleep problems among soldiers during high-stress training. Limitations include reliance on self-report and the inability to disaggregate the effects of mindfulness versus yoga. Mindfulness and yoga may enable personnel in high-stress occupations to sustain their mental health even in the context of significant psychological demands. This trial is registered with NCT05550610.
... 5,6 Although several modalities of mindfulness-based interventions are being developed, some characteristics are essential and common to all: they are grounded in theoretical and practical Buddhist traditions combined with scientific evidence, and their focus is to develop the ability of individuals to recognize triggers and alter their behavior by understanding the transient nature of their reactions to experiences. [7][8][9] Several benefits of mindfulness training have already been described in the literature. For instance, studies show that regular and frequent practice develops both state and trait mindfulness, contributing to a more mindful attitude and less distress. ...
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Introduction Systematic reviews and metanalyses have shown that mindfulness-based interventions can have positive effects on health, such as reducing anxiety, depression, and chronic pain. However, their effect on sleep-related outcomes is not yet well established. Sleep can be assessed subjectively (questionnaires, sleep logs, self-reporting) and/or objectively (actigraphy, polysomnography, biological markers), and outcomes may differ depending on which type of assessment is used. Objective In this study, we present a literature overview on mindfulness and sleep, innovatively presenting and discussing studies that address sleep subjectively and objectively. Methods The search was undertaken using four databases (Pubmed Medline, Scopus, Web of Science, Psychinfo) in September 2019, and repeated in May 2021. Studies were analyzed through a two-step process: (1) reading titles and abstracts, and (2) full text analysis that met the review's eligibility criteria, with the final sample comprising 193 articles. We observed a growth in the number of studies published, particularly since 2005. However, this was mostly due to an increase in studies based on subjective research. There is a moderate to nonexistent agreement between objective and subjective sleep measures, with results of subjective measures having higher variability and uncertainty.We identified 151 articles (78%) using an exclusively subjective sleep evaluation, which can cause a misperception about mindfulness effects on sleep. Conclusion Future studies should place greater emphasis on objective measurements to accurately investigate the effects of mindfulness practices on sleep, although subjective measures also have a role to play in respect of some aspects of this relationship.
... The two most common MBIs are MBSR, which is often recommended for people with chronic physical health problems, and Mindfulness-Based Cognitive Therapy, which was designed for people at high risk of depressive relapse. 10 According to Shapero's summary of MBIs in psychiatry, the programs generally consist of eight weekly 2-to 2.5-hour classes that carry approximately 12 patients. Additionally, these programs also often include a one-day retreat. ...
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Objectives. Nearly every modern textbook on the etiology and treatment of voice disorders (VD) recommends stress reduction for VD patients. The benefits of mindfulness for stress reduction are well documented , but published literature on mindfulness and VD is sparse. Our objective was to determine whether an 8-week mindfulness course could increase mindfulness and lower stress in people with VD, leading to a decrease in vocal handicap. Study Design. Mixed methods study. Methods. Participants: 69 individuals with VD: 39 were mindfulness course participants (MCP), 30 were in a waitlist control group (WCG). Exclusionary criteria: patients in voice therapy. Before and after the 8-week timeframe, participants took the Mindful Attention and Awareness Scale (MAAS), Perceived Stress Scale-10 (PSS-10), Voice Handicap Index (VHI), and-for singers (n = 36)-the Singing Voice Handicap Index (SVHI). Follow-up interviews were conducted with select participants. Results. In the MCP, each of the outcomes significantly changed in the direction hypothesized, resulting in increased MAAS (P = 0.000) and decreased PSS-10 (P = 0.007), VHI (P = 0.000), and SVHI (P = 0.021, n = 22) scores. Using a 2 × 2 Repeated Measures ANOVA, two outcomes were statistically different for the MCP from pre to postcourse-MAAS increased (P = 0.006, ES = 0.107) and VHI decreased (P = 0.034, ES = 0.065)-in comparison to no change in the WCG. Follow-up interviews revealed increased acceptance of the VD; reduced stress, physical tension, and pain/discomfort; increased somatic (or interoceptive) awareness; community with other VD patients; and positive speaking and singing voice changes. Conclusions. An 8-week mindfulness course shows promise for reducing stress in people with VD, lowering voice handicap, and improving quality of life. Future research should evaluate mindfulness in patients with specific voice disorders; patients with higher and lower VHI scores; singers; and patients who experience throat pain. Mindfulness should also be evaluated within a standard voice therapy protocol.
... Mindfulness-based training programs are informed by science, education, training and supervision, and contemplational practices. These programs teach foundational skills of self-regulation and attention and are non-stigmatizing (e.g., Crane et al., 2017). There is promising evidence from Randomized Controlled Trials that mindfulness-based programs reduce symptoms of depression, anxiety, and stress in adolescents ( Digital technologies, including smartphone apps, provide an important avenue to increase access to evidence-based interventions for adolescents with mental health problems (Webb et al., 2022). ...
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Background: A growing body of literature indicates that adolescent girls who talk with close friends about interpersonal problems or worries in an excessive, speculative way and with an intense focus on distress (i.e., co-rumination) are at heightened risk for developing internalizing symptoms and disorders as well as reduced friendship quality. However, to date, there are no prevention programs available that target high levels of co-rumination between adolescent girls. As such, we developed the blended school-based mindfulness prevention program Happy Friends, Positive Minds (HFPM) that targets co-rumination at the dyadic level, i.e., between two close female friends. The aim of this trial is to evaluate the effectiveness of HFPM to reduce co-rumination and internalizing problems and to enhance wellbeing and social-emotional behavior in Dutch adolescent girls. Methods: A cluster Randomized Controlled Trial (cRCT) will be conducted to evaluate HFPM effectiveness. We will recruit 160 female friendship dyads (n = 320 girls) aged 13 to 15 years who will be characterized by high levels of self-reported co-rumination. The cRCT has two arms: (1) an intervention condition in which 160 girls (80 friendship dyads) will receive the 14-week HFPM program, and (2) a control condition in which 160 girls (80 dyads) will receive care-as-usual (CAU). Data will be collected at baseline (T0: October 2023), during the program (T1: December 2023; T2: February 2024; T3: April 2024), immediately after the program (T4: July 2024) and at one-year follow-up (T5: July 2025). Participant-level self-reported risk for (early onset) depression and anxiety, self-reported and observed co-rumination, self- and friend-reported friendship quality, self-reported positive and negative affect, self-reported interpersonal responses to positive affect and self-reported anhedonia symptoms will be the outcome variables. Discussion: This study will provide insights into the short-term and long-term effects of the HFPM program on girls’ internalizing problems, wellbeing and social-emotional behavior. Trials registration: International Standard Randomized Controlled Trials, identifier: ISRCTN54246670. Registered on 27 February 2023.
... Pre-to Mid-intervention) focused on the development of mindfulness and compassion-based skills in a descriptive framework of mindfulness practice comprising Presence supported by Mindful Attention, Mindful Awareness, Mindful Attitude and Mindful Acting withIntention(Correia, 2020;Crane et al., 2017). Mindfulness and compassion were developed in the first four sessions as the foundation for engaging with graded exposure, which was included after Midintervention (i.e., Sessions 5-8). ...
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The persistence of posttraumatic stress symptoms (PTSS) can be debilitating. However, many people experiencing such symptoms may not qualify for or may not seek treatment. Potentially contributing to ongoing residual symptoms of PTSS is emotion dysregulation. Meanwhile, the research area of mindfulness and compassion has grown to imply emotion regulation as one of its underlying mechanisms; yet, its influence on emotion regulation in PTSS cohort is unknown. Here, we explored the potential effectiveness of an 8‐week Compassion‐oriented and Mindfulness‐based Exposure Therapy (CoMET) for individuals with PTSS using a waitlist control design. A total of 28 individuals (27 females, age range = 18–39 years) participated in the study (17 CoMET; 11 waitlist control). Following CoMET, participants reported significant decreases in PTSS severity (from clinical to non‐clinical levels), emotion dysregulation and experiential avoidance, as well as significant increases in mindfulness, self‐compassion and quality of life. Electroencephalogram‐based brain network connectivity analysis revealed an increase in alpha‐band connectivity following CoMET in a network that includes the amygdala, suggesting that CoMET successfully induced changes in functional connectivity between brain regions that play a crucial role in emotion regulation. In sum, the current study demonstrated promising intervention outcomes of CoMET in effectively alleviating the symptoms of PTSS via enhanced emotion regulation.
... Decentering-defined as the capacity to objectively observe one's immediate experience, altering its inherent nature-is a pivotal mechanism underpinning mindfulness meditation, namely mindfulness-based cognitive therapy (MBCT) [81]. In general, both Mindfulness-Based Interventions and Psychedelic Interventions have been recognized for their potential to cultivate decentering [82]. ...
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There has been increasing scientific and clinical interest in studying psychedelic and meditation-based interventions in recent years, both in the context of improving mental health and as tools for understanding the mind. Several authors suggest neurophysiological and phenomenological parallels and overlaps between psychedelic and meditative states and suggest synergistic effects of both methods. Both psychedelic-assisted therapy and meditation training in the form of mindfulness-based interventions have been experimentally validated with moderate to large effects as alternative treatments for a variety of mental health problems, including depression, addictions, and anxiety disorders. Both demonstrated significant post-acute and long-term decreases in clinical symptoms and enhancements in well-being in healthy participants, in addition. Postulated shared salutogenic mechanisms, include, among others the ability to alter self-consciousness, present-moment awareness and antidepressant action via corresponding neuromodulatory effects. These shared mechanisms between mindfulness training and psychedelic intervention have led to scientists theorizing, and recently demonstrating, positive synergistic effects when both are used in combination. Research findings suggest that these two approaches can complement each other, enhancing the positive effects of both interventions. However, more theoretical accounts and methodologically sound research are needed before they can be extended into clinical practice. The current review aims to discuss the theoretical rationale of combining psychedelics with mindfulness training, including the predictive coding framework as well as research findings regarding synergies and commonalities between mindfulness training and psychedelic intervention. In addition, suggestions how to combine the two modalities are provided.
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Psychosocial and behavioral interventions have been shown to significantly reduce depressive and anxiety symptoms in different populations. Recent evidence suggests that the mental health of the general population has deteriorated significantly since the start of Coronavirus Disease 2019 (COVID-19) pandemic. We conducted a systematic review and meta-analysis of studies on the therapeutic effects of psychosocial and behavioral interventions on depression and anxiety during the COVID-19 pandemic. We systematically searched six electronic databases between December 2019 and February 2022 including PubMed, PsycINFO, Scopus, Web of Science, CNKI, and Wanfang Data. We included randomized clinical trials of psychosocial and behavioral interventions in individuals with depressive or anxiety symptoms during the COVID-19 outbreak compared to various control conditions. A total of 35 eligible studies with 5457 participants were included. The meta-analysis results showed that psychosocial and behavioral interventions had statistically significant moderate effects on depression [SMD = − 0.73, 95% CI (− 1.01, − 0.45), I² = 90%] and large effects on anxiety [SMD = − 0.90, 95% CI (− 1.19, − 0.60), I² = 92%], especially in the general population and COVID-19 survivors. Exercise and cognitive behavioral therapy were found to be the most effective treatments with moderate-to-large effect size for depression and anxiety during the outbreak of COVID-19. We also found the internet-based approach could also achieve almost equally significant effects on depression and anxiety compared with face-to-face traditional approach. Our findings suggest that cognitive behavioral therapy and physical exercise intervention are significantly effective for depression and anxiety related to the COVID-19 pandemic regardless of the delivery modes, and gender differences should be taken into consideration for better implementation of interventions in clinical and community practice.
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Objective: To explore mediated effects of Mindfulness-Based Cognitive Therapy-“Taking it Further” (MBCT-TiF) on mental well-being through changes in mindfulness, self-compassion, and decentering. Method: A secondary analysis of an RCT using simple mediation, with 164 graduates of MBCT and mindfulness-based stress reduction (MBSR), was implemented whereby MBCT-TiF (vs ongoing mindfulness practice; OMP) was the independent variable; changes in mindfulness, self-compassion, and decentering during the intervention were the mediators; and mental well-being at post-intervention, whilst controlling for baseline, was the dependent variable. Secondary outcomes included psychological quality of life, depression, and anxiety. Results: Compared to OMP, MBCT-TiF experienced significant improvements in mental well-being through changes in all three mediators (mindfulness: ab = 0.11 [0.03, 0.25]; decentering: ab = 0.16 [0.05, 0.33]; self-compassion: ab = 0.07 [0.01, 0.18]). A similar pattern was demonstrated for depression, but only mindfulness and decentering mediated effects on psychological quality of life and anxiety. Conclusion: The findings provide preliminary support for all three mediators in driving change in mental well-being in a sample of MBCT/MBSR graduates. Future work must be theory-driven and powered to test all mediators in parallel and alongside other potential mediators (e.g., equanimity) to further understand independent contributions and interacting effects.
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There is expanding interest in mindfulness-based programs (MBPs) within the mainstream. While there are research gaps, there is empirical evidence for these developments. Implementing new evidence into practice is always complex and difficult. Particular complexities and tensions arise when implementing MBPs in the mainstream. MBPs are emerging out of the confluence of different epistemologies—contemplative teaching and practice, and contemporary Western empiricism and culture. In the process of navigating implementation and integrity, and developing a professional practice context for this emerging field, the diverse influences within this confluence need careful attention and thought. Both contemplative practices, and mainstream institutions and professional practice have well-developed ethical understandings and integrity. MBPs aim to balance fidelity to both. This includes the need to further develop skillful expressions of the underpinning theoretical and philosophical framework for MBPs; to sensitively work with the boundary between mainstream and religious mindfulness; to develop organizational structures which support governance and collaboration; to investigate teacher training, supervision models, and teaching competence; to develop consensus on the ethical frameworks on which mainstream MBPs rests; and to build understanding and work skillfully with barriers to access to MBPs. It is equally important to attend to how these developments are conducted. This includes the need to align with values integral to mindfulness, and to hold longer-term intentions and directions, while taking small, deliberate steps in each moment. The MBP field needs to establish itself as a new professional field and stand on its own integrity.
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Importance: Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development. Objective: To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression. Data sources: English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014. Study selection: Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care. Data extraction and synthesis: This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis. Results: Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments. Conclusions and relevance: Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
The author introduces the special section on mindfulness: four articles that between them explore the correlates of mindfulness in both cross-sectional and treatment studies. Results from these studies, taken together, suggest a close association between higher levels of mindfulness, either as a trait or as cultivated during treatment, and lower levels of rumination, avoidance, perfectionism and maladaptive self-guides. These four characteristics can be seen as different aspects of the same ‘mode of mind’, which prioritizes the resolution of discrepancies between ideas of current and desired states using a test-operate-test-exit sequence. Mindfulness training allows people to recognize when this mode of mind is operating, to disengage from it if they choose, and to enter an alternative mode of mind characterized by prioritizing intentional and direct perception of moment-by-moment experience, in which thoughts are seen as mental events, and judgemental striving for goals is seen, accepted and ‘let go’.
Since the original publication of this seminal work, acceptance and commitment therapy (ACT) has come into its own as a widely practiced approach to helping people change. This book provides the definitive statement of ACT—from conceptual and empirical foundations to clinical techniques—written by its originators. ACT is based on the idea that psychological rigidity is a root cause of a wide range of clinical problems. The authors describe effective, innovative ways to cultivate psychological flexibility by detecting and targeting six key processes: defusion, acceptance, attention to the present moment, self-awareness, values, and committed action. Sample therapeutic exercises and patient–therapist dialogues are integrated throughout. New to This Edition *Reflects tremendous advances in ACT clinical applications, theory building, and research. *Psychological flexibility is now the central organizing focus. *Expanded coverage of mindfulness, the therapeutic relationship, relational learning, and case formulation. *Restructured to be more clinician friendly and accessible; focuses on the moment-by-moment process of therapy.
Mindfulness-based approaches to clinical interventions are receiving increasing attention in psychiatric research.1 The article in this issue of JAMA Psychiatry by Kuyken et al2 is an important meta-analysis of mindfulness-based cognitive therapy (MBCT) in the prevention of depression relapse. This meta-analysis was conducted at the individual patient level and included 9 randomized clinical trials, with data available for 1258 patients who participated in studies in which MBCT was compared with at least 1 non-MBCT treatment. The findings indicate that MBCT produced a reduced risk of depressive relapse within a 60-week follow-up period compared with other active treatments. Mindfulness-based cognitive therapy was most effective for patients with greater depressive severity before treatment.
This book offers a practical and theoretical guide to the benefits of Mindfulness-Based Stress Reduction (MBSR) in the workplace, describing the latest neuroscience research into the effects of mindfulness training and detailing an eight-week mindfulness training course. Provides techniques which allow people in organizations to listen more attentively, communicate more clearly, manage stress and foster strong relationships. Includes a complete eight-week mindfulness training course, specifically customized for workplace settings, along with further reading and training resources. Written by a mindfulness expert and leading corporate trainer.
One of Andrew Mathews' most important contributions to our field has been the demonstration that anxiety is associated with an attentional bias towards threat-related material. This bias provides a plausible basis for understanding the origins and maintenance of anxiety-related disorders in terms of self-perpetuating, interacting processes: selective attention to threat means that experience is more likely to be interpreted in threatening ways; these interpretations will generate further anxiety; that anxiety will reinforce the attentional bias, and so on. From this perspective, it might seem counterproductive, even foolish, to train anxious patients to deliberately focus their attention towards unpleasant aspects of their experience. And yet this is a central component of the application of mindfulness training to emotional disorders, and there is encouraging evidence (reviewed by Baer, 2003) that such training can reduce symptoms of generalized anxiety disorder (GAD) and panic. Clearly, there is more than one way we might attend to unpleasant aspects of our experience. For example, we might attend to our unpleasant experience as if we were a scientist, curious about the precise nature of the constellation of thoughts, feelings and body sensations that comprise the experience; or, we might attend to the unpleasant experience as revealing an aspect of ourselves that we loathe and despise; or, indeed, we might attend to the unpleasant experience as a potential threat to our physical or mental well-being. In this chapter, I will consider how mindfully attending to unwanted experience may alleviate, rather than exacerbate, emotional disorders. Mindfulness, here, means ‘paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally’ (Kabat-Zinn, 1994, p. 4). © Cambridge University Press 2004 and Cambridge University Press, 2009.