Edo Shonin

Mindfulness-based interventions: towards mindful clinical integration

During 2012, over 500 scientific articles on mindfulness were published. This was more than the total number of mindfulness articles published between 1980 and 2000. A recent survey by the Mental Health Foundation (MHF) found that 75% of general practitioners in the UK believe that mindfulness is beneficial for patients with mental health problems (MHF, 2010). Indeed, recent findings indicate that Mindfulness-based interventions (MBIs) may be effective treatments for a broad range of psychological disorders and somatic illnesses (e.g., Chiesa and Serretti, 2011; Fjorback et al., 2011). Given the recent growth of interest into the clinical utility of mindfulness, an appraisal of the empirical evidence and discussion of issues that impact upon the ethical standing and credibility of MBIs is timely.

Meditation Awareness Training (MAT) for Work-related Wellbeing and Job Performance: A Randomised Controlled Trial

Due to its potential to concurrently improve work-related wellbeing (WRW) and job performance, occupational stakeholders are becoming increasingly interested in the applications of meditation. The present study conducted the first randomized controlled trial to assess the effects of meditation on outcomes relating to both WRW and job performance. Office-based middle-hierarchy managers (n = 152) received an eight-week meditation intervention (Meditation Awareness Training; MAT) or an active control intervention. MAT participants demonstrated significant and sustainable improvements (with strong effect sizes) over control-group participants in levels of work-related stress, job satisfaction, psychological distress, and employer-rated job performance. There are a number of novel implications: (i) meditation can effectuate a perceptual shift in how employees experience their work and psychological environment and may thus constitute a cost-effective WRW intervention, (ii) meditation-based (i.e., present-moment-focussed) working styles may be more effective than goal-based (i.e., future-orientated) working styles, and (iii) meditation may reduce the separation made by employees between their own interests and those of the organizations they work for.

Meditation Awareness Training (MAT) for Improved Psychological Well-being: A Qualitative Examination of Participant Experiences

Mindfulness-based interventions are reported as being efficacious treatments for a variety of psychological and somatic conditions. However, concerns have arisen relating to how mindfulness is operationalized in mindfulness-based interventions and whether its ‘spiritual essence’ and full potential treatment efficacy have remained intact. This qualitative study used interpretative phenomenological analysis to examine participant experiences regarding the acceptability and effectiveness of a newly designed secularized intervention called meditation awareness training (MAT) that follows a more traditional Buddhist approach to meditation. Participants (with issues of stress and low mood) reported experiencing improvements in psychological well-being due to receiving MAT. The wider implications are discussed.

Towards a second generation of mindfulness-based interventions

Australian & New Zealand Journal of Psychiatry, 49(7) In addition to featuring in the practice guidelines of the American Psychiatric Association and the United Kingdom’s National Institute for Health and Care Excellence for the treatment of recurrent depression in adults, emerging evidence suggests that mindfulnessbased interventions (MBIs) have applications for treating diverse psychopathologies and disorders including addictive behaviours (e.g. pathological gambling, workaholism), post-traumatic stress disorder (PTSD), anger dysregulation, attention deficit hyperactivity disorder, pain disorders (e.g. fibromyalgia), sexual dysfunction and psychotic disorders (Shonin et al., 2014). Mindfulness is also recommended by the Royal Australian and New Zealand College of Psychiatrists as a non-first-line treatment for binge eating disorder in adults. However, commensurate with growing interest into the clinical (and non-clinical) applications of MBIs, there are growing concerns over the rapidity at which mindfulness has been extracted from its traditional Buddhist setting and introduced into psychiatric treatment domains (Van Gordon et al., 2015). Specifically, these concerns centre on the alleged absence within the first-generation MBIs (FG-MBIs) of the factors that, according to the 2500-year-old system of Buddhist meditative practice, are deemed to maximise the efficacy of mindfulness. Simply put, some researchers, clinicians and Buddhist scholars have suggested that mindfulness in MBIs has been altered from its traditional Buddhist construction to such an extent that it is inaccurate and/or misleading to refer the resultant technique as ‘mindfulness’. To address these concerns, a number of second-generation MBIs (SG-MBIs) have recently been formulated and empirically investigated. Thus, we explicate the key differences between FG-MBIs and SG-MBIs, appraise key empirical findings and issues relating to SG-MBIs and discuss the implications of the trend towards a second generation of MBIs for psychiatrists and service users.

Emotional Regulation and Depression: A Potential Mediator between Heart and Mind

A narrative review of the major evidence concerning the relationship between emotional regulation and depression was conducted. The literature demonstrates a mediating role of emotional regulation in the development of depression and physical illness. Literature suggests in fact that the employment of adaptive emotional regulation strategies (e.g., reappraisal) causes a reduction of stress-elicited emotions leading to physical disorders. Conversely, dysfunctional emotional regulation strategies and, in particular, rumination and emotion suppression appear to be influential in the pathogenesis of depression and physiological disease. More specifically, the evidence suggests that depression and rumination affect both cognitive (e.g., impaired ability to process negative information) and neurobiological mechanisms (e.g., hypothalamic pituitary adrenal axis overactivation and higher rates of cortisol production). Understanding the factors that govern the variety of health outcomes that different people experience following exposure to stress has important implications for the development of effective emotion-regulation interventional approaches (e.g., mindfulness-based therapy, emotion-focused therapy, and emotion regulation therapy).

Do mindfulness-based therapies have a role in the treatment of psychosis?

Mindfulness is a form of meditation that originates from Buddhist practice and was first introduced into Western clinical settings in the 1970s. The practice of mindfulness is fundamentally concerned with developing an open and unbroken awareness of present moment cognitive-effective and sensory experience. According to Shonin et al. (2013a), mindfulness effectuates a greater perceptual distance from distorted cognitive and affective processes and this metaawareness facilitates the regulation (i.e., via the non-reactive observance) of habitual maladaptive responses. During the last two decades, a credible evidence base has emerged supporting the utilisation of mindfulness meditation in the treatment of mood and anxiety disorders, and a mindfulness interventional approach (known as Mindfulness Based Cognitive Therapy (MBCT)) is now advocated by the National Institute for Health and Clinical Excellence (NICE) and the American Psychiatric Association for the treatment of specific forms of depression. Accordingly, in recent years, clinical attention has begun to focus on the utility of mindfulness for treating other psychopathologies including psychotic disorders. Psychotic experiences are typified by different degrees of reality distortion as well as deficits in orientating response (e.g., circumstance, place, and identity) and perceptual skills (Chadwick et al., 2005). Meditation is a subtle process in which, whether effectuated by direct means (i.e., meditative analysis) or indirect means (i.e., present-moment observance), the meditation practitioner is ultimately compelled to question not only the nature of reality, but also their ontological stance (i.e., how, or even whether the ‘self’ actually exists) (Shonin et al., 2013b). Given that this subtle process can be extremely challenging and confusing even for people of ‘healthy’ clinical status, the question arises whether it is prudent to utilise a meditation-based recovery model for people with psychosis. To date, empirical evidence relating to this question has differed considerably. This viewpoint provides: (i) a concise review and appraisal of empirical findings supporting or opposing the operationalisation of mindfulness for the treatment of psychotic disorders, (ii) a discussion of whether mindfulness should be deployed as a treatment for psychosis, and (iii) recommendations for practice and research.

Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the Treatment of Co-occurring Schizophrenia and Pathological Gambling: A Case Study

There is a paucity of interventional approaches that are sensitive to the complex needs of individuals with co-occurring schizophrenia and pathological gambling. Utilizing a single-participant design, this study conducted the first clinical evaluation of a novel and integrated non-pharmacological treatment for a participant with dual-diagnosis schizophrenia and pathological gambling. The participant underwent a 20-week treatment course comprising: (i) an initial phase of second-wave cognitive behavioral therapy (CBT), and (ii) a subsequent phase employing a meditation-based recovery model (involving the administering of an intervention known as Meditation Awareness Training). The primary outcome was diagnostic change (based on DSM-IV-TR criteria) for schizophrenia and pathological gambling. Secondary outcomes were: (i) psychiatric symptom severity, (ii) pathological gambling symptom severity, (iii) psychosocial functioning, and (iv) dispositional mindfulness. Findings demonstrated that the participant was successfully treated for both schizophrenia and pathological gambling. Significant improvements were also observed across all other outcome variables and positive outcomes were maintained at 3-month follow-up. An initial phase of CBT to improve social coping skills and environmental mastery, followed by a phase of meditation-based therapy to increase perceptual distance from mental urges and intrusive thoughts, may be a diagnostically-syntonic treatment for co-occurring schizophrenia and pathological gambling.

Work-Related Mental Health and Job Performance: Can Mindfulness Help?

Work-related mental health issues such as work-related stress and addiction to work impose a significant health and economic burden to the employee, the employing organization, and the country of work more generally. Interventions that can be empirically shown to improve levels of work-related mental health—especially those with the potential to concurrently improve employee levels of work performance—are of particular interest to occupational stakeholders. One such broad-application interventional approach currently of interest to occupational stakeholders in this respect is mindfulness-based interventions (MBIs). Following a brief explication of the mindfulness construct, this paper critically discusses current research directions in the utilization of mindfulness in workplace settings and assesses its suitability for operationalization as an organization-level work-related mental health intervention. By effecting a perceptual-shift in the mode of responding and relating to sensory and cognitive-affective stimuli, employees that undergo mindfulness training may be able to transfer the locus of control for stress from external work conditions to internal metacognitive and attentional resources. Therefore, MBIs may constitute cost-effective organization-level interventions due to not actually requiring any modifications to human resource management systems and practises. Based on preliminary empirical findings and on the outcomes of MBI studies with clinical populations, it is concluded that MBIs appear to be viable interventional options for organizations wishing to improve the mental health of their employees.

The treatment of workaholism with Meditation Awareness Training: A Case Study

INTRODUCTION The prevalence of workaholism in Western populations is approximately 10%, although estimates vary considerably according to how “workaholism” is defined. There is growing consensus that workaholism is a bona fide behavioral addiction that exists at the extreme end of the work-engagement continuum and causes similar negative consequences to other behavioral addictions such as salience, conflict, tolerance, withdrawal symptoms, and mood modification. Other more specific consequences include burnout, work compulsion, work–family conflict, impaired productivity, asociality, and psychological/somatic illness. Recent decades have witnessed a marked increase in research investigating the etiology, typology, symptoms, prevalence, and correlates of workaholism. However, despite increasing prevalence rates for workaholism, there is a paucity of workaholism treatment studies. Indeed, guidelines for the treatment of workaholism tend to be based on either theoretical proposals or anecdotal reports elicited during clinical practice. Thus, there is a need to establish dedicated and effective treatments for workaholism. A novel broad-application interventional approach receiving increasing attention by occupational and healthcare stakeholders is that of third-wave cognitive behavioral therapies (CBTs). Third-wave CBTs integrate aspects of Eastern philosophy and typically employ a meditation-based recovery model. A primary treatment mechanism of these techniques involves the regulation of psychological and autonomic arousal by increasing perceptual distance from faulty thoughts and mental urges. A “meditative anchor,” such as observing the breath, is typically used to aid concentration and to help maintain an open-awareness of present-moment sensory and cognitive–

Meditation Awareness Training for the Treatment of Sex Addiction: A Case Study

Background Sex addiction is a disorder that can have serious adverse functional consequences. Treatment effectiveness research for sex addiction is currently underdeveloped, and interventions are generally based on the guidelines for treating other behavioral (as well as chemical) addictions. Consequently, there is a need to clinically evaluate tailored treatments that target the specific symptoms of sex addiction. It has been proposed that second-generation mindfulness-based interventions (SG-MBIs) may be an appropriate treatment for sex addiction because in addition to helping individuals increase perceptual distance from craving for desired objects and experiences, some SG-MBIs specifically contain meditations intended to undermine attachment to sex and/or the human body. The current study conducts the first clinical investigation into the utility of mindfulness for treating sex addiction. Case presentation An in-depth clinical case study was conducted involving an adult male suffering from sex addiction that underwent treatment utilizing an SG-MBI known as Meditation Awareness Training (MAT). Following completion of MAT, the participant demonstrated clinically significant improvements in addictive sexual behavior, as well as reductions in depression and psychological distress. The MAT intervention also led to improvements in sleep quality, job satisfaction, and non-attachment to self and experiences. Salutary outcomes were maintained at 6-month follow-up. Discussion and conclusion The current study extends the literature exploring the applications of mindfulness for treating behavioral addiction, and findings indicate that further clinical investigation into the role of mindfulness for treating sex addiction is warranted.