Mindfulness

Overview

Individuals who often experience some emotion or pain, but are oblivious to this feeling or discomfort until some time later, frequently engage in tasks without really being aware of their behavior, and tend to reflect upon the past or plan the future instead of attending to ongoing activities are less likely to feel satisfied with life and experience a sense of wellbeing (Brown & Ryan, 2003). The concept of mindfulness can explain this observation.

Mindfulness refers to a psychological state in which individuals experience an awareness of objects in their immediate environment as well as their current thoughts and feelings (Brown & Ryan, 2003). When eating a meal, for example, they direct their attention to the immediate tastes as well as feel aware of their increasing sense of satiation, even distention of the stomach (Brown & Ryan, 2003).

Because their attention is directed to immediate--not past or future--experiences, these objects, thoughts, and feelings are perceived accurately, devoid of bias and distortions (Brown & Ryan, 2004b). In addition to curbing bias, this diversion of attention from the past ensures that reactions to events are adaptive not automatic or rote sequences of actions (Bishop, Lau, Shapiro, Carlson, Anderson, et al., 2004).

Definition

Individuals who demonstrate mindfulness direct their attention to their present surroundings and their psychological state, but engage in experiential rather than analytical processing. That is, mindfulness refers to sustained or frequent awareness and attention to current and ongoing experiences.

Hence, mindfulness departs from other forms of awareness, such as rumination, self monitoring, and need for cognition, all of which are characterized by analytical, logical, rational forms of processing information (Brown & Ryan, 2003). That is, unlike these other forms of awareness, mindfulness does not involve cognitive reflection and analysis.

More precisely, Germer (2005) defined the three interrelated constituents of mindfulness. First, mindfulness involves a sense of awareness. That is, involves feel aware rather than hazy. Second, this awareness is directed to their ongoing experience. In other words, individuals feel aware of their immediate experiences and environment--and do not direct their attention to past events or future possibilities. Third, this awareness of ongoing experience does not involve any judgment, evaluation, and even elaboration (cf., Kabat-Zinn, 1994). That is, their thoughts, feelings, sensations, and urges are all accepted rather than judged.

The term mindfulness can be used in different contexts. That is, sometimes mindfulness refers to a description of some state-a state characterized as a sense of uncritical awareness of ongoing experience. Alternatively, mindfulness can represent an intervention, usually involving meditation, in which individuals learn how to evoke this state of awareness. Finally, mindfulness can be conceptualized as a mental process, rather than as a state, underpinning self regulation (Brown & Ryan, 2003) or acceptance (Linehan, 1994).

Dimensions of mindfulness

Some scholars have proposed that mindfulness might entail multiple, distinct facets or dimensions. Bishop (2002), for example, distinguishes between awareness of ongoing experiences and the absence of any judgment or evaluation of these experiences. Similarly, when various measures of mindful behaviors were subjected to a factor analysis, five dimensions emerged: level of awareness, judgment, reactivity, description, and observation. In contrast, other scholars have challenged these attempts to enumerate the facets of mindfulness, conceptualizing this state or process as a unified phenomenon (e.g., Ivanovski & Malhi, 2007).

Evolution and history of mindfulness

Mindfulness ultimately emanated from Buddhist teachers. Nevertheless, several strands of research popularized the concept in psychological literature. For example, from a gestalt perspective, Perls (1973) contended that individuals form alienated, neglected, or biased memories of experience. In a relaxed state, individuals can convert these experiences into clear perceptions, which can be integrated into the self and promote wellbeing.

In the arena of psychology, mindfulness was first applied and evaluated formally within the context of an approach, characterized by Kabat-Zinn (1982), called Mindfulness Based Stress Reduction. Typically, the intervention lasts eight or so weeks and combines elements of mindfulness meditation and yoga. Individuals learn how to maintain awareness of their immediate environment and experiences, while accepting themselves unconditionally rather than judging critically. Techniques include the body scan, in which individuals become aware of the feelings and sensations in each part of their body. In addition, individuals learn how to integrate these techniques into everyday life. Improvements in symptoms lasting over 15 months have been demonstrated (Kabat-Zinn, Lipworth, & Burney, 1985)

Since this time, mindfulness has been incorporated into other paradigms. Specifically, mindfulness has been integrated with cognitive behavioral therapy, which evolved into an approach called mindfulness-based cognitive therapy (Segal, Williams, & Teasdale, 2002). Similarly, mindfulness is integral to acceptance and commitment therapy as well (Hayes & Wilson, 1994). Finally, dialectical behavior therapy, as delineated by Linehan (1993), also represents mindfulness mediation as one of the five key facets. This form of therapy was first designed to treat borderline personality disorder, involving emotional regulation.

In these paradigms, mindfulness meditation is assumed to be distinct from most alternative forms of meditation (see Lutz, Slagter, Dunne, & Davidson, 2008). In many traditional forms of meditation, individuals attempt to orient their attention towards a single entity: a candle, a word, an image, and so forth. They attempt to distract their attention from all other objects and thoughts. In mindfulness meditation, however, individuals attempt to maintain awareness on any ongoing mental experiences or events. They do not necessarily confine their attention to one specific object or thought-although inadvertent fixation is possible (Lutz, Slagter, Dunne, & Davidson, 2008).

Consequences

Mindfulness, which divorces individuals from their preconceptions and biases, might improve their capacity to regulate emotions effectively (Brown & Ryan, 2004a). Indeed, many studies have shown that training that is intended to facilitate mindfulness improves wellbeing (Kabat-Zinn, 1990; Shapiro, Schwartz, & Bonner, 1998; Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau, 2000).

Mindfulness is positively related to subjective wellbeing, life satisfaction, and self esteem, as well as inversely related to depression and anxiety (Brown & Ryan, 2003). These relationships tend to persist even after emotional intelligence, private self consciousness, neuroticism, and extraversion are controlled.

Benefits in clinical settings

A variety of studies have shown that attempts to instill mindfulness can alleviate mood disorders. That is, interventions that introduce or entail mindfulness have been shown to ameliorate symptoms of anxiety (Evans, Ferrando, Findler, Stowell, Smart, & Haglin, 2008), trauma (Follette, Palm, & Pearson, 2006) as well as depression (Kingston, Dooley, Bates, Lawlor, & Malone, 2007).

Nevertheless, the benefits of mindfulness are not confined to mood disorders. Such interventions have also been shown to curb psychosis (Bach & Hayes, 2002; Gaudiano & Herbert, 2006), exhibitionism (Paul, Marx, & Orsillo, 1999), eating disorders (Telch, Agras, & Linehan, 2000), and other disorders. Furthermore, even physical conditions, such as chronic pain (Kabat-Zinn, 1982; see also chronic pain), are amenable to the benefits of mindfulness.

Mindfulness is more likely to surface when individuals refrain from denying or suppressing previous failures and, therefore, tends to correspond to accurate rather than biased perceptions, promoting many benefits. Individuals who report a mindful disposition, for example, are less likely to exhibit pathological gambling because they do not overestimate the frequency of their victories-a common source of gambling problems (Lakey, Campbell, Brown, & Goodie, 2007).

Although these findings are certainly encouraging, not all of these studies establish whether a state of mindfulness does indeed mediate the benefits of these interventions. Conceivably, some other properties of these interventions, such as the novelty, could improve measures of wellbeing.

Defense mechanisms

Usually, when individuals are exposed to some consequential threat, a series of defense mechanisms are elicited. If they consider their own mortality, for example, they feel the need to defend their worldviews and collectives (see Terror management theory). Mindfulness has been shown to curb these defensive responses (Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, & Ryan, 2010).

For example, in one study, some participants were encouraged to consider their mortality. Furthermore, the extent to which American participants subsequently prefer presentations that vindicate, rather than question, their nation was assessed--a measure of worldview defense. If individuals reported elevated levels of trait mindfulness, the usual worldview defense in response to mortality salience diminished. That is, participants who maintain awareness of their feelings, sensations, and environment did not act as defensively in response to mortality salience (Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, & Ryan, 2010).

The final studies examined the mechanisms that underpinned these effects. Specifically, as these studies showed, when trait mindfulness was elevated, participants spent more time writing about their mortality. Thoughts about death were also more accessible in these individuals (Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, & Ryan, 2010). These findings indicate that participants did not evoke defense mechanisms to circumvent existential anxiety--that is anxiety about their inevitable mortality.

Antecedents of mindfulness

Several factors can interfere with this awareness and attention, ultimately curbing mindfulness, as delineated by Brown and Ryan (2003). First, rumination over the past or fantasies over the future can distract attention from ongoing events. Second, the distribution of attention to several concurrent tasks can also impede mindfulness. Third, habitual and automatic behavior, without any awareness or attention, reduces mindfulness. Finally, denial or suppression, often intended to circumvent undesirable emotions, also impairs mindfulness.

Mechanisms that underpin the benefits of mindfulness

Self determination and autonomy

Self determination theory, propounded by Deci and Ryan (1980, 1985), is sometimes invoked to explain the benefits of mindfulness (Brown & Ryan, 2003). In particular, mindfulness might correspond to an awareness of personal needs, values, and interests. As a consequence, individuals are able to choose courses of action that align with their core values, which ultimately promotes wellbeing (Ryan & Deci, 2000).

Consistent with this premise, Brown and Ryan (2003) showed that individuals who report elevated scores of mindfulness also feel their desire for autonomy, competence, and connections with other people are fulfilled. When individuals experience a state of mindfulness, they are also more inclined to engage in activities because they align to their value or interest, not because of demands from anyone else. Furthermore, when mindfulness is elevated, explicit and implicit measures of affect are more likely to concur. This observation also indicates that mindfulness might facilitate an awareness of unconscious needs and inclinations.

Modest desires

Mindfulness might also curb unrealistic or lofty goals and desires, which can enhance wellbeing. In a study conducted by Brown, Kasser, Ryan, Linley, and Orzech (2009), for example, participants answered a series of questions that gauge their level of mindfulness as well as their current and desired financial status diverge, with questions such as "How well does your current financial status right now approach what you want". Furthermore, their emotional state and satisfaction with life was assessed to gauge subjective wellbeing.

Mindfulness was inversely related to the discrepancy between current and desired financial status. Interestingly, this relationship was observed even after annual income, household income, savings, debt, and assets were controlled. In other words, mindfulness seems to improve satisfaction with financial status, regardless of actual wealth. Accordingly, when individuals experience a mindful orientation, their desired level of wealth seems to dissipate, which in turn evokes happiness and satisfaction (Brown, Kasser, Ryan, Linley, & Orzech, 2009). Furthermore, the same pattern of results emerged when training was convened to manipulate levels of mindfulness (Brown, Kasser, Ryan, Linley, & Orzech, 2009).

Several mechanisms might underpin the observation that mindfulness curbs lofty financial goals (see Burch, 2000; Rosenburg, 2004). First, when individuals adopt a mindful orientation, they tend to appreciate their immediate subjective experiences in lieu of material goods. The importance of wealth and status tends to wane (Brown & Kasser, 2005).

Second, because mindful individuals are more attuned to their intrinsic desires, they might be less susceptible to advertising. In contrast, the desired wealth of other individuals might soar as a consequence of advertising campaigns and other social forces (Brown, Kasser, Ryan, Linley, & Orzech, 2009).

Finally, when individuals demonstrate a mindful state, they are more likely to accept their circumstances and state (e.g., Baer, 2003). This acceptance might extend to their financial status as well.

Relaxation

Conceivably, as several authors acknowledge (e.g., Dunn, Hartigan, & Mikulas, 1999), the benefits of mindfulness could merely be ascribed to affective states, such as relaxation. Certainly, mindfulness does reduce anxiety or arousal (Kabat-Zinn, 1990), and such emotional states or moods can enhance resilience and promote other benefits (e.g., Kuhl, 2000; see Personality systems interaction theory).

Despite the affective consequences of mindfulness meditation, such practices are not intended to improve emotional states immediately. Indeed, mindfulness should enable individuals to experience and recognize negative affect rather than suppress or evade these emotions (e.g., Kabat-Zinn, 2003).

Specific attributions

Mindfulness might also curb the inclination of individuals to form global negative evaluations about themselves. To illustrate, some individuals extract broad negative attributions about themselves from specific events. They might perceive themselves as hopeless in general after failures in specific contexts only--an attribution style that is associated with depression. This inclination to form global evaluations also coincides with memories of general, rather than specific, autobiographical events. Mindfulness, in which individuals orient their attention to the specific context, rather than connect event to past or future episode, has been shown to ameliorate this inclination and thus, at least sometimes, could prevent depression (Williams, Teasdale, Segal, & Soulsby, 2000).

Cognitive defusion

Mindfulness meditation might increase the capacity of individuals to detach themselves from their thoughts. Some individuals conceptualize their thoughts, such as the words "I am too fat", as a veridical reflection of reality. As a consequence, the responses that such reality might evoke--such as urges to shun social situations as well as feelings of shame--are also elicited by the thought (Masuda, Hayes, Sackett, & Twohig, 2004; see ACT therapy).

After mindfulness training, however, individuals might assume that thoughts are not necessarily representations of reality. These thoughts, instead, are conceptualized as transient, ephemeral events--a process called cognitive defusion (Hayes, 2003; Hayes, Strosahl, & Wilson, 1999).

After this realization, the thoughts are less likely to evoke the sequence of responses that an authentic event might elicit. Instead, individuals can respond more flexibly rather than rigidly. Furthermore, individuals do not feel the urge to inhibit, evade, or modify these thoughts. These thoughts are not tangible problems that need to be defeated (cf., Baer, 2003). Even repeating an upsetting thought, deliberately and audibly, for over half a minute can foster these benefits (Masuda, Hayes, Sackett, & Twohig, 2004).

Indeed, many of the accounts and narratives that relate to mindfulness allude to this detachment from thoughts. Brown, Ryan, and Creswell (2007), for example, maintain that mindfulness instills a dislocation between the objects of which individuals are aware and the responses that such stimuli would usually evoke. Likewise, Kabat-Zinn (1990) introduced the concept of choiceless awareness, in which individuals become aware of some experience or object, without the need to engage, evaluate, or elucidate this stimulus.

Diminution of defensive reactions

When individuals experience some problem or difficulty, a host of defensive reactions often ensue. They might, for example, attempt to suppress their emotions or evade some setting in the future. Similarly, they might divorce themselves from social interactions, because of a sense of distrust, roughly corresponding to an insecure attachment (see attachment theory).

Some evidence indicates that mindfulness might preclude some of these maladaptive defensive reactions. Mindfulness, for example, is associated with acceptance of negative emotions or thoughts (Brown & Ryan, 2004; Hayes, 1994; Roemer & Orsillo, 2002). As a consequence, the inclination to suppress emotions--an inclination that often aggravates these feelings (Wegner, 1994)--diminishes (see Ironic rebound). Furthermore, mindfulness may be related to a secure rather than insecure attachment style (Shaver, Lavy, Saron, & Mikulincer, 2007).

Neurological underpinnings

Many studies have explored the neurological correlates of mindfulness meditation (e.g., Davidson, Kabat-Zinn, Schumacher, Rosenkranz, Muller, Santorelli et al., 2003). Mindfulness meditation does indeed correspond to a specific profile of brain activation--a profile that persists after the meditation session is completed (Lutz, Greischar, Rawlings, Ricard, & Davidson, 2004). Indeed, voxel-based morphometry, which is used to examine the volume of brain structures, has shown volumetric change after mindfulness meditation is practiced (Holzel, Ott, Gard, Hempel, Weygandt, Morgen, et al., 2007). The level of change tends to correlate with the hours of practice (Lazar, 2005).

Mindfulness might also be associated with right lateralized activation of the prefrontal cortex, including the ventromedial prefrontal cortex, the dorsolateral prefrontal cortex, and the insula (Farb, Segal, Mayberg, Bean, McKeon, Fatima, et al., 2007). Specifically, these regions are associated with an orientation, called experiential focus, in which individuals focus their attention on momentary experiences rather than strive to integrate ongoing events with more enduring representations of themselves. In contrast, other midline regions, such as the medial prefrontal cortex, seem to mediate a narrative focus, in which individuals relate immediate events to more enduring traits about themselves, sometimes provoking rumination. This region also relates to memory of traits, knowledge about the self, and aspirations of the future--somewhat akin to a promotion focus (see Regulatory focus theory).

Practical implications

Mindfulness training

Many practitioners now engage in training that is intended to facilitate mindfulness--a program that spans several weeks or months. Speca, Carlson, Goodey, and Angen (2000), for example, describe this training program in some detail. First, participants receive theoretical information, such as the recognition that relaxing the body can facilitate a calm mental state. Second, they practice techniques that are intended to promote mindfulness. Finally, they discuss their experiences with these techniques in a group setting, partly intended to uncover measures to redress impediments to effective practice.

In particular, the program comprises several phases. First, individuals engage in relaxation exercises, involving deep breathing and awareness of various bodily sensations. Second, individuals engage in visualization exercises, imagining particular tastes, demonstrating the relationships between mental and physical responses. In addition, individuals are asked to direct their attention to each part of the body in sequence, focusing on the sensations they experience, and encouraged to complete this exercise at home. Third, information about the physiological correlates of stress and the use of breathing as an anchor for attention are presented. Fourth, using these breathing exercises in everyday contexts, such as walking, is discussed.

After individuals practice these exercises, they receive information about cognitive distortions and irrational assumptions. Individuals learn to monitor these cognitive appraisals and challenge these distorted beliefs. Visualizing peaceful images to amplify mindfulness is introduced.

Individual solutions

Rather than participate in official training, individuals can engage in some exercises to foster mindfulness, attempting to circumvent the tendencies that obstruct this mental state. First, every hour or so, individuals could sit quietly for a few minutes, focusing their attention on their breath. They could, then, reflect upon their surroundings or their mental state-their emotions, thoughts, and so forth.

Second, individuals should attempt to undertake one task at a time, not shifting erratically across activities. They could, for example, decide to maintain focus on one task for at least 15 minutes before then contemplating the next activity.

Third, every week, individuals should attempt to identify one thought or feeling they might be suppressing or neglecting-perhaps a concern over their behavior towards a friend, perhaps their worry they might not be able to fulfill some deadline. They could reflect upon this thought or feeling, for a moment, without attempting to generate solutions. They should merely be aware of this cognition or emotion.

Measures

Brown and Ryan (2003) developed and validated the Mindful Attention Awareness Scale, or MAAS, to measure individual differences in mindfulness. Participants answer 15 items, such as "I find myself doing things without paying attention", "I find it difficult to stay focused on what is happening in the present", "I could be experiencing some emotion and not be conscious of it until some time later", and "I rush through activities without being really aware of them" on a six point rating scale. Because individuals are probably more cognizant of mindlessness than mindfulness, all of the items portray neglect, distraction, or oblivion rather than awareness or attention and are reverse coded.

Brown and Ryan (2003) uncovered encouraging psychometric properties. Confirmatory factor analysis revealed that items all corresponded to a single dimension, with Cronbach's exceeding .8. Retests after four weeks uncovered an intraclass correlation of .81 and no significant differences across time. The scale is not significantly correlated with the MMPI lie scale but moderately correlated with the Marlowe-Crowne measure of social desirability. Furthermore, consistent with hypotheses, mindfulness was shown to be elevated in members of a Zen community center compared to individuals in the general population, establishing known group validity.

Overlapping but distinct concepts

Mindfulness does overlap with a variety of concepts, as highlighted by Brown and Ryan (2003). Clarity about emotions, a facet of emotional intelligence (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995), is likely to be associated with mindfulness. Likewise, some facets of openness--particularly openness to ideas and feelings--should be related to mindfulness as well.

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Created by Dr Simon Moss on 18/10/2008

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