J. Brantley

Effects of mindfulness-based stress reduction on emotional experience and expression: a randomized controlled trial†

OBJECTIVES Mindfulness-based stress reduction (MBSR) has been found to reduce psychological distress and improve psychological adjustment in medical, psychiatric, and nonclinical samples. We examined its effects on several processes, attitudes, and behavior patterns related to emotion regulation. DESIGN Fifty-six adults were randomly assigned to MBSR or to a waiting list (WL). RESULTS Compared with WL completers (n = 21), MBSR completers (n = 20) reported significantly greater increases in trait mindfulness and decreases in absent-mindedness, greater increases in self-compassion, and decreases in fear of emotions, suppression of anger, aggressive anger expression, worry, and difficulties regulating emotions. The WL group subsequently received MBSR, and the two groups combined showed significant changes on all of these variables from pre-MBSR to post-MBSR, and on all except the 2 anger variables from pre-test to 2-month follow-up, as well as significant reductions in rumination. CONCLUSION An 8-week mindfulness training program might increase mindful awareness in daily life and have beneficial impact on clinically relevant emotion regulation processes.

Mindfulness-Based Stress Reduction

Is there a connection between being healthy and being more consciously present? Do meditation practices that emphasize nonjudging awareness promote movement toward greater levels of health, including improvements in anxiety and related disorders? Can one successfully assume a larger degree of responsibility for one’s own health by adopting a personal meditation practice? Is it possible to establish an effective and broadly replicable training program in mindfulness meditation that appeals to individuals of diverse social, medical, and spiritual backgroundswhoshare a common motivation to improve their personal health outcomes? Mindfulness-based stress reduction (MBSR) was born of such questions.

Mechanisms of Change in Mindfulness-Based Stress Reduction: Self-Compassion and Mindfulness as Mediators of Intervention Outcomes

Research has demonstrated support for the efficacy of mindfulness-based stress reduction (MBSR) in alleviating psychological distress and symptoms. Less is known, however, about the mechanisms through which MBSR achieves its outcomes. This study examined mindfulness and self-compassion as potential mediators of MBSR’s effects on several processes and behaviors related to emotion regulation, using data from a randomized trial of MBSR versus waitlist (WL), in which MBSR participants demonstrated significantly greater improvements in worry, fear of emotion, difficulties in emotion regulation, suppression of anger, and aggressive anger expression. Mediation analysis using bootstrap resampling indicated that increases in self-compassion mediated MBSR’s effects on worry, controlling for change in mindfulness. Increases in mindfulness mediated the intervention’s effects on difficulties in emotion regulation, controlling for change in self-compassion. Both variables mediated MBSR’s effects on fear of emotion. These findings highlight the importance of mindfulness and self-compassion as key processes of change that underlie MBSR’s outcomes.

Mindfulness and Anxiety Disorders: Developing a Wise Relationship with the Inner Experience of Fear

Perhaps no condition better illustrates the intimate relationship between brain and behavior – mind and body – as the inner experience of fear. In this chapter, we present an integrative scientific view of anxiety and clinical anxiety disorders, with an emphasis on awareness and acceptance as a foundation for mind/body health. Whereas anxiety-related psychopathology is characterized by a desire to avoid the inner experience of fear, we postulate that practicing mindfulness can promote a wise and accepting relationship with one’s internal cognitive, emotional, and physical experience, even during times of intense fear or worry. Further, we suggest that the “wise relationship” that develops by turning toward fear, anxiety, and panic with stable attention, present focused awareness, acceptance, and self-compassion can promote psychological freedom from persistent anxiety and greater behavioral flexibility. Mindfulness is a word that refers to a basic human capacity for nonconceptual, non-judging, and present-moment-centered awareness. This awareness arises from intentionally paying attention, from noticing on purpose what is occurring inside and outside of oneself, with an attitude of friendliness and acceptance toward what is happening while it is happening. Mindfulness has been cultivated by human beings using “inner technologies” of meditation in various spiritual contexts for literally thousands of years. In the past 25–30 years, Western medical science has turned increasing attention to the psychological and physical correlates of meditation and mindfulness practices (Walsh & Shapiro, 2006). Modern clinical investigators have joined meditation teachers in offering definitions of mindfulness (see Table 10.1).

Decreased Symptoms of Depression After Mindfulness-Based Stress Reduction: Potential Moderating Effects of Religiosity, Spirituality, Trait Mindfulness, Sex, and Age

OBJECTIVE Mindfulness-based stress reduction (MBSR) is a secular meditation training program that reduces depressive symptoms. Little is known, however, about the degree to which a participants spiritual and religious background, or other demographic characteristics associated with risk for depression, may affect the effectiveness of MBSR. Therefore, this study tested whether individual differences in religiosity, spirituality, motivation for spiritual growth, trait mindfulness, sex, and age affect MBSR effectiveness. METHODS As part of an open trial, multiple regression was used to analyze variation in depressive symptom outcomes among 322 adults who enrolled in an 8-week, community-based MBSR program. RESULTS As hypothesized, depressive symptom severity decreased significantly in the full study sample (d=0.57; p<0.01). After adjustment for baseline symptom severity, moderation analyses revealed no significant differences in the change in depressive symptoms following MBSR as a function of spirituality, religiosity, trait mindfulness, or demographic variables. Paired t tests found consistent, statistically significant (p<0.01) reductions in depressive symptoms across all subgroups by religious affiliation, intention for spiritual growth, sex, and baseline symptom severity. After adjustment for baseline symptom scores, age, sex, and religious affiliation, a significant proportion of variance in post-MBSR depressive symptoms was uniquely explained by changes in both spirituality (β=-0.15; p=0.006) and mindfulness (β=-0.17; p<0.001). CONCLUSIONS These findings suggest that MBSR, a secular meditation training program, is associated with improved depressive symptoms regardless of affiliation with a religion, sense of spirituality, trait level of mindfulness before MBSR training, sex, or age. Increases in both mindfulness and daily spiritual experiences uniquely explained improvement in depressive symptoms.

Mindfulness Meditation Targets Transdiagnostic Symptoms Implicated in Stress-Related Disorders: Understanding Relationships between Changes in Mindfulness, Sleep Quality, and Physical Symptoms

Mindfulness-Based Stress Reduction (MBSR) is an 8-week meditation program known to improve anxiety, depression, and psychological well-being. Other health-related effects, such as sleep quality, are less well established, as are the psychological processes associated with therapeutic change. This prospective, observational study (n = 213) aimed to determine whether perseverative cognition, indicated by rumination and intrusive thoughts, and emotion regulation, measured by avoidance, thought suppression, emotion suppression, and cognitive reappraisal, partly accounted for the hypothesized relationship between changes in mindfulness and two health-related outcomes: sleep quality and stress-related physical symptoms. As expected, increased mindfulness following the MBSR program was directly correlated with decreased sleep disturbance (r = −0.21, p = 0.004) and decreased stress-related physical symptoms (r = −0.38, p < 0.001). Partial correlations revealed that pre-post changes in rumination, unwanted intrusive thoughts, thought suppression, experiential avoidance, emotion suppression, and cognitive reappraisal each uniquely accounted for up to 32% of the correlation between the change in mindfulness and change in sleep disturbance and up to 30% of the correlation between the change in mindfulness and change in stress-related physical symptoms. Results suggest that the stress-reducing effects of MBSR are due, in part, to improvements in perseverative cognition and emotion regulation, two “transdiagnostic” mental processes that cut across stress-related disorders.