Mechanism of Mindfulness

Question 1

Buddhism and the West

Answer 1

•Evidence of early influence of Buddhism 
on ancient Greece
•Did not spread systematically to West 
until 19th Century -e.g., German 
philosopher Arthur Schopenhauer

Question 2

Surge of interest in Buddhism and

Eastern Philosophies

Answer 2

•A “surge of interest” in Buddhism occurred
after the Second World War.
•There were many factors that started an
interest in Eastern philosophies and religions in 1960s and 1970s (e.g., Beatles George Harrison and John Lennon and
Hare Krishna).
•Alan Watts was a particularly prolific writer of Eastern philosophy. Relevant for psychology was his book Psychotherapy East and West.

Question 3

Mindfulness in psychological therapy

Answer 3

•The systematic use of mindfulness in psychological therapy
began in the 1990s. The following widely-used therapy types
are all sometimes grouped together as mindfulness-based
interventions (MBIs):
•Dialectical Behavior Therapy (DBT)
•Acceptance and Commitment Therapy (ACT)
•Mindfulness-Based Stress Reduction (MBSR)
•Mindfulness-Based Cognitive Therapy (MBCT)

Question 4

Mindfulness prior to MBIs: Part 1

Answer 4

 Mindfulness is certainly not a new invention of MBIs. All major religions of the world contain traditions and techniques that foster mindfulness (chanting, prayer, etc). However, the term has never been used that way before.
 Every religion has its mystics. However, it is safe to argue that Buddhism places much more explicit emphasis on mindfulness than other religions.

Question 5

Mindfulness prior to MBIs: Part 2

Answer 5

 Recently, new forms of Christian meditation have become popular. But most Westerners make contact with mindfulness training via yoga, a Buddhist group or as part of psychological therapy.
 Psychotherapy has been using related concepts (free association, decentering, deautomizationetc.), but these are not directly equivalent to mindfulness.

Question 6

Trait/skill definitions of mindfulness

Answer 6

•Being a psychological construct, mindfulness needs to be
inferred and cannot be measured directly.
•Most definitions include references to attention, awareness
and a non-judgmental attitude.
•Kabat-Zinn(1994) defined it as “paying attention in a
particular way: on purpose, in the present moment, and
non-judgmentally”.

Question 7

Mindfulness-informed approaches

Answer 7

•Meditation and related exercises are generally considered central to developing mindfulness.
•This is what distinguishes so-called mindfulness-based
approaches (where it is central) from mindfulness-informed
approaches (where mindfulness may be part of some exercises and there isn’t the same disciplined practice)
•An example of the latter is ACT:

Question 8

Acceptance and Commitment Therapy (ACT): Part 1

Answer 8

• Developed by the psychologist Stephen Hayes.
• As the name implies, ACT’s goals are about mindful acceptance
of unwanted thoughts and feelings as well as commitment to act according to one’s values.
• People often place too much emphasis on the literal content of thoughts, which in conditions such as depression is perpetuated in a continuous vicious cycle.

Question 9

Acceptance and Commitment Therapy (ACT): Part 2

Answer 9

• Clients are taught to stop identifying themselves with the thoughts and instead focus back on the process of thinking.
• For example, a person with low self-esteem might verbalize the following thought: “I am worthless”. The client learns to reframe this thought into: “I am having the thought that I am worthless”.

Question 10

Mindfulness exercises in ACT: Part 1

Answer 10

• Clients are instructed to be mindful in the present moment and to practice acceptance and awareness of negative thoughts even though they generally tried to avoid them before.
• Clients also commit to clear goals. After having achieved a habit of acceptance and awareness of one’s thoughts, these may now change:

Question 11

Mindfulness exercises in ACT: Part 2

Answer 11

A person with an anxiety disorder, for example, might learn to accept anxiety and reframe the therapeutic goal from recovery of anxiety to leading a meaningful life. They thus learn to live with anxiety but focus on what is important to their lives.
• While ACT uses stories, conversations, paradoxes and exercises to promote mindfulness in the client, these are not used to solve the behavior problem with logical reasoning but through the experience of mindfulness.

Question 12

Mindfulness-Based Stress Reduction (MBSR)

Answer 12

• Developed by Jon Kabat-Zinn.
• As the name implies, it was designed for stress reduction, but also as a tool to cope with chronic pain.
• Meditation is a central part of a course that is typically 8-10 weeks long. Around 10-30 participants gather for weekly 2-to 2.5-hour sessions, and one full-day workshop.
• Outside the class, participants are requested to meditate daily for 45 min and to complete homework to apply mindfulness into their daily lives.
• One of the major goals of the program is to foster a nonjudgmental attitude. People develop a habit of observing the content of their thoughts without judging them and to return their attention to the present moment.

Question 13

Mindfulness exercises in MBSR

Answer 13

•Apart from mindfulness meditation, participants
practice yoga, breathing exercises, as well as mindful
eating, mindful walking, mindful dishwashing…
•The body scan exercise gets participants to lie down with their eyes closed. Gradually, they are asked to observe the sensations in the various parts of the body, one at a time

Question 14

Mindfulness-Based Cognitive Therapy (MBCT): Part 1

Answer 14

Developed by the Segal, Williams, and Teasdale.
• This therapy is directly based on the MBSR program, but was designed to be a program to prevent relapse from depression.
• Traditional cognitive therapy treats depression by teaching people to replace negative thoughts (e.g. self-talk such as “I am overweight and ugly”) with
rational ones (“I am not more overweight than most people my age”). While this might work, clients are still vulnerable to relapse.

Question 15

Mindfulness-Based Cognitive Therapy (MBCT): Part 2

Answer 15

MBCT teaches clients to stop identifying themselves with thoughts and in
this way attempts to prevent depression from re-occurring.
• They learn to notice, without judging, that thoughts come and go.

Question 16

Effectiveness of MBSR

Answer 16

•The effectiveness of MBSR has been studied much more than other therapies (with depression, chronic pain, coping with cancer, heart disease, and also general population with no specific problems).
•In cancer patients, it leads to better mood, better sleep quality and reduced stress.
•However, meditation is more than simply relaxation.
•In patients with chronic pain, the goal is not to strive to
reduce pain, but to observe sensations and emotions as
they happen in the moment.
•A famous saying goes: “Pain is inevitable, suffering is
optional”.

Question 17

Mindfulness as a “complex” intervention

Answer 17

Mindfulness interventions have been described as a
complex intervention according to the guidelines of
the Medical Research Council of the UK
•This is because of the complexity of behaviours required by the course facilitators and participants to engage in, variability of outcomes and the fact that interventions typically permit (even encourage) a degree of flexibility to meet needs of participants

Question 18

Informal Mindfulness

Answer 18

•Generalisingformal mindfulness practices into everyday life
•Attention on water while taking a shower
•Mindfully engaging in household tasks
•“Surfing the urge” –increased awareness of physical
sensations as urges are noticed and observed; watching
them rise and fall

Question 19

Mindfulness diary: Part 1

Answer 19

 It is very common for mindfulness teachers to encourage using a diary where observations around one’s mindfulness are recorded daily
 Additionally, recording length of daily session serves as a
reminder for participants to practice (and is already an
intervention)

Question 20

Mindfulness diary: Part 2

Answer 20

 The narrative part of the diary helps reflect on application of mindfulness in everyday life
 It helps us really how often we are actually absentminded (in psychometrics called response shift)
 It also helps build insight –increased meta-emotional
awareness (under which circumstances do you tend to behave in a certain way?)

Question 21

Concentration versus Insight Meditation

Answer 21

 A common distinction made to describe meditation techniques is in terms of concentration (Samatha) versus insight (Vipassana) meditation
 Concentration meditation teaches focused attention on a single object or event (usually breath); often considered beginner’s practice (although opinions vary)
 Open monitoring: expand attentionalscope to any experience that may arise, without selecting, over-identifying, judging, or focusing on a particular object

Question 22

Four Foundations of Mindfulness

Answer 22

•Insight meditation is based on the Satipatthana Sutra or the Four Foundations of Mindfulness
•In stages, you develop mindfulness of the body, feelings or
sensations, mind or consciousness, and so-called dhamma(mental objects)
•One thus learns to see the truth of reality or the true nature of phenomena as arising and fading away

Question 23

Measuring mindfulness

Answer 23

• Being a psychological construct, mindfulness needs
to be inferred and cannot be measured directly.
•Reviews of recent mindfulness questionnaire show a wide range of different question content.
•Only a small number of questionnaires are about mindfulness states (in other words, how mindful one feels at the present moment).
•Most questionnaires provide trait measures. This does not imply that one’s degree of mindfulness cannot change, but it is assumed to occur gradually with increased practice.
•People with no experience in mindfulness training vary substantially in terms of their mindfulness score.

Question 24

MAAS

Answer 24

• The Mindfulness Attention and Awareness Scale (MAAS) has 15 statements, and the respondent ticks the appropriate answer on a Likertscale (1= “strongly disagree, 2= “disagree”,…).
• All answers are converted into one single score.
• Example question:
• “I find myself doing things without paying attention”

Question 25

FMI

Answer 25

• The Freiburg Mindfulness Inventory (FMI) has 30 statements, and the respondent ticks the appropriate answer on a Likertscale (1= “strongly disagree, 2= “disagree”, …).
• All answers are converted into one single score.
• Example question:
• “I am open to the experience of the present moment”

Question 26

FFMQ

Answer 26

• The Five Facet Mindfulness Questionnaire (FFMQ) has 37statements with a Likertscale.
• Scores are calculated for five different subscales:
• Observing: “I notice the smells and aromas of things”
• Describing: “I’m good at finding the words to describe my feelings”
• Acting with awareness: “I break or spill things because of carelessness, not paying attention, or thinking of something else”
• Nonjudging: “I tend to evaluate whether my perceptions are right or wrong”
• Nonreacting: “I perceive my feelings and emotions without having to react to them”

Question 27

Giving questionnaires to monks: Part 1

Answer 27

•Christopher et al. (2009) gave the MAAS and KIMS to
Theravada monks and American university students.
•The monks had higher scores on awareness, but lower scores on observing and accepting without judgment. The problem is that this kind of exercise is littered with biases related to language (e.g. translations, different connotations) and culture.

Question 28

Giving questionnaires to monks: Part 2

Answer 28

•Fenget al. (2018) conducted a cognitive interviewing study
with more questionnaires and senior Buddhist from a variety
of traditions. They concluded that mindfulness in Buddhism
differs in terms of characteristics they described as purposeful, skillful, ethical, and profound.

Question 29

Mindfulness in Buddhism is discussed in the context of the

eightfold path, and here it is only one element:

Answer 29

• right/correct/complete/wholesome view (wisdom/prajñā)
• right intention(wisdom/śīla)
• right speech(ethics/śīla)
• right action(ethics/śīla)
• right livelihood(ethics/śīla)
• right effort(concentration/samādhi)
• right mindfulness(sammasati)(concentration/samādhi)
• right concentration(concentration/samādh

Question 30

The role of morality in MBIs

Answer 30

 There is no prescribed way of morality in MBIs (to avoid clashing with other belief systems), but this does not mean that it plays no role.
 Everybody entering such a program will have been exposed to morality through socialisationand even education and bring with them their own guidelines.
 There are reports that people develop more compassion naturally, even when loving-kindness meditation is not explicitly instructed (Maex, 2011).
 Cullen (2011) argues that the intention to cause harm and
mindfulness are mutually exclusive states.

Question 31

Compassion and Self-compassion

Answer 31

•So-called self-compassion intervention have become very
popular recently
•Self-compassion scores are often highly correlated with
mindfulness (although might also be due to the fact that
development of these scales used mindfulness as discriminant validity criterion)
•Useful for people who tend to exhibit a lot of guilt and shame
•Cebollaet al. (2017) included compassion meditation in their typology, which was associated with unique aspects in the FFMQ

Question 32

Neurophysiology of Mindfulness: EEG

Answer 32

 Davidson et al. (2003) compared cortical activity of
25 participants after 8 weeks MBSR to 16 wait-list
controls.
 Significantly higher left-side anterior activation
(C3/4) - linked to positive affective style was
reported for mindfulness group compared to controls.
 This study also gave participants an influenza vaccine
to test their immune system.
 Significant rise of antibody cells associated with
mindfulness compared to control group.
 Also, decrease of negative affect & anxiety were
reported.

Question 33

Mindfulness: Neuroimaging: Part 1

Answer 33

 Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. Relies on the fact that cerebral blood flow and neuronal activation are coupled.
 Volume of Grey matter (darker tissue of the brain) correlates negatively with attention task performance & age in normal, non-meditative population but
 not in experienced Zen practitioners.
 Older we are the less grey matter we have and the poorer our ability for attention task performance

Question 34

Mindfulness: Neuroimaging: Part 2

Answer 34

 These findings suggest that Zen meditation practice may preventage-related cognitive deterioration by inhibiting reduction of grey matter volume (Pagnoni & Cekic, 2007)
 Recent study reported increased grey matter density in the brain regions involved in emotion regulation, learning, memory and self-related cognitions after MBSR training. (Hölzel et al., 2011)

Question 35

Effects of Mindfulness

Answer 35

 Massion et al. (1995) found that experienced
meditators had significantly higher melatonin
levels.
 Since higher melatonin levels are linked to
improved immune function, they speculated that
regular meditation might lead to improved
outcomes for breast and prostate cancer.

Question 36

Neurophysiology of Mindfulness:

Conclusions

Answer 36

 “Mindfulness is proposed to be a unique form of higher-order information processing in which subjective assessment of transient events is silenced in favour of maintaining objectivity and gaining insight” (Ives-Deliperi et al., 2011, p. 240).
 Mindfulness may promote psychological health through disintegration of both self-concept and permanent sense of self (Martin, 1997).
 Mindfulness may enhance unfocused and sustained attention capacity, memory and executive function.
 Limitations: methodology and lack of research on pure mindfulness.

Question 37

Research using self-report

Answer 37

 Most research relies on self-report measures
such as questionnaires.
 The results from these studies can then be
analysed statistically to test various hypotheses
about the mechanisms by why mindfulness is
assumed to exert its health benefits.
 Techniques used here are structural equation
modelling

Question 38

Conclusions

Answer 38

 Western mindfulness-based interventions have received much attention in recent years, but research has now entered a phase where the effectiveness of mindfulness no longer needs to be demonstrated, rather the mechanism by which this happens does (Williams & Kabat-Zinn, 2011).
 More detailed mechanisms are to be tested empirically.
 A challenge also continues to be agreeing on a suitable definition of mindfulness

Question 39

What about religious practices?

Answer 39

•Second-generation (SG) mindfulness-based interventions
promote explicitly spiritual content as opposed to first-
generation (FG) programmesthat may be criticisedfor
introducing Buddhism by stealth (Van Gordon et al., 2015)
•Of course, some of the characteristics of religious mindfulness practice can be explained in secular terms:
• Devotional aspects and therapeutic
• Meaningfulness and long-term practice
• Cultural factors
•At the end of the day, most people these days bring a lot of experience with them. It is often difficult to separate
secular from religious practice.

Question 40

Religious-themed programmes

Answer 40

•In addition to Second-generation (SG) mindfulness-based
interventions, religious-themed programmesare increasingly being offered, such as Christian, Muslim, and Buddhist.
•Here, it is even more important to be transparent about the content of these programmes.
•Scientific evaluation of the effectiveness also need to proceed with caution so that religious and cultures values are not transgressed.
•For Buddhist contexts, Krägelohet al. (2022,
https://doi.org/10.1007/s12671-022-01884-w) therefore proposed the approach of Science-Based Buddhist Practice, where the delineation between area of faith and those of practice are clearly made.