Mindfulness as Mediator

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Background. Mindfulness is a core element of spiritual practices. Recently, the psychological construct mindfulness has received a great deal of theoretical attention concerning its potential role in positive psychological functioning. Yet little research has examined whether interventions can me

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Mindfulness as Mediator

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1. Mindfulness as Mediator Shauna L. Shapiro, Ph.D. Doug Oman, Ph.D. Carl E. Thoresen, Ph.D. Thomas G. Plante, Ph.D. Tim Flinders, B.A.

2. Background Mindfulness is a core element of spiritual practices. Recently, the psychological construct mindfulness has received a great deal of theoretical attention concerning its potential role in positive psychological functioning. Yet little research has examined whether interventions can measurably increase mindfulness, and what are its beneficial effects. The current randomized controlled trial examined the effects of two meditation-based interventions on the construct of mindfulness itself to determine if mindfulness can be developed and if the development of mindfulness leads to positive changes.

3. Mindfulness “To See Clearly”

4. Mindfulness Defined “The awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment to moment.” Kabat-Zinn, 2003, p. 145

5. Core Elements of Mindfulness Paying attention = Attention On purpose = Intention Nonjudgmentally = Attitude

6. Mindfulness

7. Mindfulness is considered a skill that can be developed through meditation practice. Yet little research has explicitly examined what types of practices actually cultivate mindfulness.

8. The current study compared the effects on mindfulness of two distinct meditation interventions: 1. Mindfulness-Based Stress Reduction 2. Eswaran Eight Point Program

9. PURPOSE (1) To evaluate the effects on cultivating mindfulness (2) To determine if mindfulness and/or adherence to treatment mediated positive well-being outcomes

10. METHODS 47 participants were randomly allocated between the MBSR (n=16) and EPP (n=16) training groups, and a wait-list control group (n=15). Pretest, posttest, and 8-week follow-up data were gathered on self-report outcome measures.

11. INTERVENTIONS Mindfulness-Based Stress Reduction (MBSR) Easwaran’s Eight Point Program (EPP) Both group trainings took place in 8 weekly meetings of 90 minutes each. Each involved instruction in a form of sitting meditation, informal corollary practices, and cultivation of attitudinal and motivational supports.

12. MBSR MBSR intervention modeled after the MBSR training developed by Kabat-Zinn and colleagues. Participants received training in (1) “Mindful Sitting Meditation” (2) “Body Scan,” (3) “Mindful Movement, and (4) Lovingkindness meditation. Inherent in all these techniques is an emphasis on mindfulness, intentionally bringing attention to present moment in a nonjudgmental way. In addition to formal meditation practices, didactic presentation and dialogue emphasized how to bring mindfulness into daily life, including topics such as mindful eating, mindfulness in relationship, mindfulness at work and school, and a mindful approach to pain, suffering and stress.

13. EPP EPP instruction emphasized core Eight Point Program practices. Point 1: Passage Meditation, the foundation of the EPP, is a concentrative method of sitting meditation where the focus is not on the breath (as in MBSR), but on a memorized inspirational passage. During sitting meditation, one slowly mentally recites a memorized passage from a scripture or a major spiritual figure. Point 2 of the EPP involves frequent repetition throughout the day of a mantram, sometimes called a holy name, such as Om mani padme hum (Buddhist), Jesus (Christian), or others from all major traditions. A mantram is used to stabilize attention throughout the day. Points 3 (slowing down) and 4 (focused attention), also practiced throughout the day, involve cultivating mental habits and states that are similar to mindfulness. The remaining points were presented more briefly: 5) training the senses, 6) putting others first, 7) spiritual fellowship, and 8) inspirational reading.

14. MBSR and EPP Both programs are integrated and incorporate multiple practices that perform many analogous functions, however, these functions are sometimes accomplished in different ways. For example: MBSR program uses sitting meditation that emphasizes mindfulness, whereas the EPP program uses a concentrative method. MBSR program has a strong mindful movement component, whereas the EPP program teaches the mantram and other practices that can be combined with everyday movements, such as walking, to foster integration of body and mind. MBSR teaches sitting meditation that incorporates a wider attentional field, the EPP program encourages wider attention through “slowing down.” MBSR explicitly encourages cultivation of loving kindness and compassion, the EPP encourages cultivation these through “putting others first” as well as meditating on passages that endorse kindness and compassion.

15. Measures MINDFULNESS: Mindful attention and awareness scale (MAAS; see Brown & Ryan, 2003). 15-item trait measure of one’s ability to attend to present moment experiences in everyday activities. Likert scale ranging from 0 (almost always) to 6 (almost never) to assess such items as, “I find myself listening to someone with one ear, doing something else at the same time” and “I tend to walk quickly to get where I’m going without paying attention to what I experience along the way” Reliable internal consistency (coefficient alpha = .82). Scores on the MAAS are significantly higher for practitioners of mindfulness meditation than for control groups of non-meditators.

16. Additional Measures Perceived stress was measured with a 10-item version of the well-known Perceived Stress Scale developed by Cohen and colleagues (Cohen & Williamson, 1988). Rumination was measured with a 12-item subscale of the Rumination and Reflection Questionnaire (Trapnell & Campbell, 1999). Forgiveness of others was measured with a 6-item subscale of the Heartland Forgiveness Scale (Thompson & Snyder, 2003).

17. Adherence Measures Adherence during training. Meditation practice was measured by self-report diaries that recorded daily practice. The MBSR group was instructed in four types of practice: 1) formal sitting practice, 2) mindful movement, 3) body scan meditation, and 4) informal practices. At each subsequent meeting (weeks 2 through 8), MBSR participants reported the number of minutes that they had engaged in each practice during each day of the previous week. The average number of minutes per day was calculated. EPP participants were instructed in formal sitting meditation at Meeting 1, mantram repetition at Meeting 4, and spiritual reading at Meeting 6. Means were calculated from their reported number of minutes engaged in sitting meditation (7 weeks’ reports) and reading (2 weeks’ reports). Also calculated was the mean number of occasions during the day in which participants repeated the mantram (4 weeks’ reports).

18. Participants Undergraduate students at a private Jesuit University Primarily 18 years old (59%), first-year (66%), female (80%), white (73%), and were Roman Catholic (49%) or had no religious affiliation (42%). 44 of 47 participants in the intervention groups completed: Our post-randomization dropout rate of 6%, is lower than most meditation intervention studies.

19. Hypotheses Hypothesis 1: Do MBSR and EPP intervention cultivate mindfulness as compared to a wait-list control group? Hypothesis 2: Do increases in mindfulness mediate positive change in outcome measures? Hypothesis 3: Does adherence predict positive change in outcome measures?

20. RESULTS Hypothesis 1: MBSR and EPP interventions each significantly increased mindfulness compared to the no treatment control group. Main effects on mindfulness were about 2/3 of a standard deviation above the control group. Notably, treatment effects on mindfulness (MAAS) were larger at 8-week follow-up than at post-test, significantly so (p<.05) for the EPP intervention. Such gains over time are unusual and contrast with the more common observation of temporal decay of many types of treatment effects. However, these findings are consistent with the definition of mindfulness as a skill that can be developed over time with practice hierarchical linear models (HLMs)hierarchical linear models (HLMs)

21. Results: Hypothesis 2 & 3 Hypothesis 2 Increases in mindfulness significantly mediated reductions in perceived stress and rumination, but not forgiveness. Hypothesis 3 In the MBSR group, two measures of diary adherence were predictive: informal practices predicted less stress (p<.05) and mindful movement predicted forgiveness (p < .10). Similarly, in the EPP group, diary records of mantram and sitting each predicted less stress and more forgiveness. Less stress was also predicted by EPP diary records of spiritual reading (p<.05).

22. Future Directions The current findings are consistent with preliminary research that mindfulness can be cultivated and mindfulness is beneficial for one’s well being. It will be important for future research to continue to broaden the exploration of how to teach mindfulness, specifically in what capacity and in what context. Future research could help determine if specific practices and contexts are more suited to specific populations versus others. Finally, it will be important to explore mechanisms of action, determining the processes through which mindfulness brings about positive change.

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