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Six recent research papers on mindfulness: outcome reviews, brain changes, self-compassion, current depression, and overview

Here are half a dozen interesting recent papers on mindfulness that have caught my eye.  Mindfulness research is roaring ahead a bit like a runaway train (probably not an ideal analogy for this subject matter), so it's good to get regular reviews of where we're getting to.  The first two papers I mention are "a synthesis of the empirically supported advantages of mindfulness" by Davis & Haye, including "research on therapists who meditate and client outcomes of therapists who meditate", and a review of "the empirical literature on the effects of mindfulness on psychological health" by Keng & colleagues (full details and links to all articles mentioned are given further down this blog post). 

I also give details of a paper by Hölzel, Carmody (a productive researcher in this area) & colleagues on anatomical brain changes achieved over an eight week Mindfulness-based stress reduction course.  This does suggest that MBSR has a skills-learning, practice-derived set of benefits and appears to support a get-on-with-it and put-in-the-hours parallel to achieving physical fitness.  So the authors report "Whole brain analyses identified increases in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum in the MBSR group compared with the controls. The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking."

Fourthly I mention a fascinating paper by Van Dam et al - "Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression" - which reports "The present study compared ability of the Self-Compassion Scale (SCS) and the Mindful Attention Awareness Scale (MAAS) to predict anxiety, depression, worry, and quality of life in a large community sample seeking self-help for anxious distress (N = 504). Multivariate and univariate analyses showed that self-compassion is a robust predictor of symptom severity and quality of life, accounting for as much as ten times more unique variance in the dependent variables than mindfulness. Of particular predictive utility are the self-judgment and isolation subscales of the SCS."  This is helpful to know but also can be a little muddling.  I find it very useful to see mindfulness as a multi-faceted construct, probably currently best measured with variations of the Five facet mindfulness scale - see the blog post "A better way to measure mindfulness: a short form of the five facet questionnaire" for more on this.  It's looking increasingly likely (as more & more research emerges) that for distress reduction (probably the commonest reason for attending a mindfulness training - or following the Buddhist eightfold path!) increases in the Non-judge and Non-react (and possibly Act-aware) facets are particularly important.  For improvement in positive mood though, it may be that Observe and Act-aware facets are more relevant.  See, for example, papers by Kohls et al on "Facets of mindfulness" and Schroevers et al on "Is learning mindfulness associated with improved affect?" for more on this.  The reason I somewhat labour this point is that the "Mindful Attention Awareness Scale" used in Van Dam's research focuses particularly on the mindfulness facet of Act-aware which - without Non-judge & Non-react - we don't expect to be an adequate measure of the link between mindfulness & distress.  In contrast, the "Self-Compassion Scale" is a very good measure of the mindfulness facet of Non-judge which we predict is likely to be the key facet in the link between mindfulness & symptom severity.      

The fifth paper I want to highlight is by van Aalderen & colleagues.  Mindfulness-based cognitive therapy (MBCT) was developed as a treatment for people in remission from recurrent episodes of depression who wanted to develop a method of reducing their vulnerability to relapse.  It's been less clear how relevant MBCT is for people who are still actively depressed.  In their paper - "The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode" the authors conducted a randomized controlled trial and reported that - for people who had already experienced at least three episodes of depression - "The study findings suggest that MBCT is as effective for patients with recurrent depression who are currently depressed as for patients who are in remission."  Encouraging in that this importantly extends the populations who we can expect are likely to benefit from MBCT.

Lastly in this list of six recent papers is the overview by Hayes et al - "Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies" - which looks at a raft of therapies including Mindfulness-based stress reduction, Mindfulness-based cognitive therapy, Mindfulness-based relapse reduction, Compassionate mind training, Metacognitive therapy, Behavioural activation, Integrative behavioural couple therapy, Dialectical behaviour therapy and Acceptance & commitment therapy.  The authors write "A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These "third wave" methods all emphasize the context and function of psychological events more so than their validity, frequency, or form ... ".  It's a good overview and helpful in keeping a broad-focus when thinking about mindfulness interventions. 

Davis, D. M. and J. A. Hayes (2011). "What are the benefits of mindfulness? A practice review of psychotherapy-related research" Psychotherapy: Theory/Research/Practice/Training 48(2): 198-208.  Research suggests that mindfulness practices offer psychotherapists a way to positively affect aspects of therapy that account for successful treatment. This paper provides psychotherapists with a synthesis of the empirically supported advantages of mindfulness. Definitions of mindfulness and evidence-based interpersonal, affective, and intrapersonal benefits of mindfulness are presented. Research on therapists who meditate and client outcomes of therapists who meditate are reviewed. Implications for practice, research, and training are discussed.

Keng, S.-L., M. J. Smoski, et al. (2011). "Effects of mindfulness on psychological health: A review of empirical studies." Clinical Psychology Review 31(6): 1041-1056. Within the past few decades, there has been a surge of interest in the investigation of mindfulness as a psychological construct and as a form of clinical intervention. This article reviews the empirical literature on the effects of mindfulness on psychological health. We begin with a discussion of the construct of mindfulness, differences between Buddhist and Western psychological conceptualizations of mindfulness, and how mindfulness has been integrated into Western medicine and psychology, before reviewing three areas of empirical research: cross-sectional, correlational research on the associations between mindfulness and various indicators of psychological health; intervention research on the effects of mindfulness-oriented interventions on psychological health; and laboratory-based, experimental research on the immediate effects of mindfulness inductions on emotional and behavioral functioning. We conclude that mindfulness brings about various positive psychological effects, including increased subjective well-being, reduced psychological symptoms and emotional reactivity, and improved behavioral regulation. The review ends with a discussion on mechanisms of change of mindfulness interventions and suggested directions for future research.

Hölzel, B. K., J. Carmody, et al. (2011). "Mindfulness practice leads to increases in regional brain gray matter density." Psychiatry Research: Neuroimaging 191(1): 36-43. Therapeutic interventions that incorporate training in mindfulness meditation have become increasingly popular, but to date little is known about neural mechanisms associated with these interventions. Mindfulness-Based Stress Reduction (MBSR), one of the most widely used mindfulness training programs, has been reported to produce positive effects on psychological well-being and to ameliorate symptoms of a number of disorders. Here, we report a controlled longitudinal study to investigate pre-post changes in brain gray matter concentration attributable to participation in an MBSR program. Anatomical magnetic resonance (MR) images from 16 healthy, meditation-naïve participants were obtained before and after they underwent the 8-week program. Changes in gray matter concentration were investigated using voxel-based morphometry, and compared with a waiting list control group of 17 individuals. Analyses in a priori regions of interest confirmed increases in gray matter concentration within the left hippocampus. Whole brain analyses identified increases in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum in the MBSR group compared with the controls. The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

Van Dam, N. T., S. C. Sheppard, et al. (2011). "Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression." Journal of Anxiety Disorders 25(1): 123-130.  Mindfulness has received considerable attention as a correlate of psychological well-being and potential mechanism for the success of mindfulness-based interventions (MBIs). Despite a common emphasis of mindfulness, at least in name, among MBIs, mindfulness proves difficult to assess, warranting consideration of other common components. Self-compassion, an important construct that relates to many of the theoretical and practical components of MBIs, may be an important predictor of psychological health. The present study compared ability of the Self-Compassion Scale (SCS) and the Mindful Attention Awareness Scale (MAAS) to predict anxiety, depression, worry, and quality of life in a large community sample seeking self-help for anxious distress (N = 504). Multivariate and univariate analyses showed that self-compassion is a robust predictor of symptom severity and quality of life, accounting for as much as ten times more unique variance in the dependent variables than mindfulness. Of particular predictive utility are the self-judgment and isolation subscales of the SCS. These findings suggest that self-compassion is a robust and important predictor of psychological health that may be an important component of MBIs for anxiety and depression.

van Aalderen, J. R., A. R. Donders, et al. (2011). "The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial." Psychol Med: 1-13.  BACKGROUND: The aim of this study is to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in addition to treatment as usual (TAU) for recurrent depressive patients with and without a current depressive episode. Method: A randomized, controlled trial comparing MBCT+TAU (n=102) with TAU alone (n=103). The study population consisted of patients with three or more previous depressive episodes. Primary outcome measure was post-treatment depressive symptoms according to the Hamilton Rating Scale for Depression. Secondary outcome measures included the Beck Depression Inventory, rumination, worry and mindfulness skills. Group comparisons were carried out with linear mixed modelling, controlling for intra-group correlations. Additional mediation analyses were performed. Comparisons were made between patients with and without a current depressive episode. RESULTS: Patients in the MBCT+TAU group reported less depressive symptoms, worry and rumination and increased levels of mindfulness skills compared with patients receiving TAU alone. MBCT resulted in a comparable reduction of depressive symptoms for patients with and without a current depressive episode. Additional analyses suggest that the reduction of depressive symptoms was mediated by decreased levels of rumination and worry. CONCLUSIONS: The study findings suggest that MBCT is as effective for patients with recurrent depression who are currently depressed as for patients who are in remission. Directions towards a better understanding of the mechanisms of action of MBCT are given, although future research is needed to support these hypotheses.

Hayes, S. C., M. Villatte, et al. (2011). "Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies." Annual Review of Clinical Psychology 7(1): 141-168.  A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These "third wave" methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term "contextual cognitive behavioral therapy" to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes.

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