Research roundup: Mindfulness-based stress reduction

This issue focuses on recent research related to moderators of mindfulness-based stress reduction (MBSR) intervention effectiveness.

Mindfulness-based stress reduction (MBSR) is a therapeutic intervention that teaches individuals how to increase their mindfulness, or their ability to attend to their moment-to-moment emotional, cognitive and physical experiences in a nonjudgmental fashion, through yoga and meditation. Individuals progressively learn to become more aware of the connection between their mind and body and can come to understand how everyday subconscious thoughts and behaviors underlie their emotional, physical and spiritual health. 

Originally created by Jon Kabat-Zinn, PhD, in 1979, this intervention, which typically lasts eight weeks but can be shortened, has since been used with both clinical and nonclinical populations of adults to reduce stress and anxiety, chronic pain, high blood pressure, sleep disturbances and other health concerns.

Over the past decade, research on the topic of mindfulness and the positive benefits associated with its practice, such as increased life satisfaction and reductions in perceived stress, has increased dramatically. However, research has also shown that MBSR is more effective for some individuals than others (Cordon, Brown, & Gibson, 2009). Understanding why these individual differences exist will help clinicians individually tailor MBSR programs to maximize efficacy for their clients. The following research summaries examine moderators of MBSR effectiveness. Specifically, discomfort with emotion, depressive symptom severity, age and trait mindfulness were analyzed.

In addition to the research summaries below, psychologists can visit the links at the end of the article to learn more about practicing mindfulness outside of a formal MBSR setting as well as current research on the benefits of mindfulness for clients and therapists.

Sass, S. M., Berenbaum, H., & Abrams, E. M. (2013). Discomfort with emotion moderates distress reduction in a brief mindfulness intervention. International Journal of Behavioral Consultation and Therapy, 7(4), 24-27.

Summary

The authors sought to examine whether discomfort with emotional experience moderated distress reduction from pre- to post-MBSR intervention. Discomfort with emotional experience has been previously associated with psychopathology (for example, generalized anxiety disorder and depression). Twenty-four adults, primarily Caucasian females, completed measures of discomfort with emotion and psychological distress one week before the first session (baseline) and completed the latter measure again immediately before the final session of a brief MBSR program. The MBSR program consisted of five sessions over a period of two and a half weeks. Only individuals who had moderate scores on the measure of distress were included in the study.

Results revealed that individuals lower in discomfort with emotion showed a sharper decrease in psychological distress from baseline to the final MBSR session than those who self-reported greater discomfort with their emotions.

Practical Implications

This study illustrates that, while still effective at reducing psychological distress regardless of discomfort with emotions, those who experience less discomfort with emotional experiences benefit more from MBSR intervention.

Clinicians may wish to evaluate their client’s level of discomfort with emotions before recommending MBSR. Although recent research suggests that shortened MBSR, like the version utilized in this study, is no less effective than longer formats in lessening psychological distress, it is possible that individuals high in emotional discomfort may benefit more from a longer intervention or an initial focus on emotion tolerance prior to MBSR. If recommending MBSR, therapists may want to help foster comfort with emotions in their clients through activities designed to increase emotional intelligence.

Gallegos, A. M., Hoerger, M., Talbot, N. L., Moynihan, J. A., & Duberstein, P. R. (2013). Emotional benefits of mindfulness-based stress reduction in older adults: The moderating roles of age and depressive symptom severity. Aging & Mental Health, 17(7), 823-829. doi: 10.1080/13607863.2013.799118

Summary

Framed within the Motivational Theory of Life-Span Development, the authors investigated whether depressive symptom severity and age of older adults moderated changes in positive affect from pre- to post-MBSR intervention. Two hundred older adults were randomly assigned to receive MBSR treatment or to be a waitlist control. Participants completed two measures of depression and a measure of positive affect at baseline, immediately after the eight-week MBSR intervention, and at a six-month follow up assessment. Participants over 70 years of age were considered old-older adults and those under 70 years were considered young-older adults.

Change in positive affect from baseline to treatment completion and from baseline to the six-month follow up was examined using multiple regressions. Results suggested that MBSR was most effective for old-older adults with lower baseline depressive symptoms, while old-older adults with higher baseline depressive symptoms reported the least improvement. There were no significant effects of age, baseline depressive symptoms or their interaction on positive affect in the waitlist control group.

Practical Implications

This article suggests that, at least among older adults, age and depressive symptom severity play an interactive role in predicting MBSR intervention effectiveness.

While older adults might show some benefit from MBSR, clinicians may wish to assess the person’s depressive symptoms regardless of clinical diagnosis in order to maximize the effectiveness of MBSR.

Shapiro, S. L., Brown, K. W., Thoresen, C., & Plante, T. G. (2011). The moderation of mindfulness-based stress reduction effects by trait mindfulness: Results from a randomized controlled trial. Clinical Psychology, 67(3), 267-277. doi: 10.1002/jclp.20761

Summary

The authors sought to investigate whether levels of trait mindfulness moderated the benefits of a MBSR intervention compared to a waitlist control group. Trait mindfulness here is defined as “a tendency to attend to present moment experiences in everyday activities.” The study utilized a longitudinal randomized controlled trial in which outcomes were assessed in a sample of 30 undergraduate students at pre-intervention, immediately post-intervention, and at two- and 12-month follow-up points. Participants completed self-report measures on mindfulness, rumination, perceived stress, subjective well-being, self-compassion, hope, empathy and forgiveness of others at all time points.

Results revealed that, relative to controls, the MBSR intervention was associated with increased mindfulness, interpersonal (for example, empathy) and subjective well-being at the two-month follow up. In addition to the benefits listed above, at the 12-month follow-up, MBSR was associated with larger increases in psychological resilience (for example, hope) and decreases in perceived stress.

Furthermore, trait mindfulness moderated MBSR intervention effects, such that MBSR participants with higher levels of pre-intervention trait mindfulness documented larger increases in mindfulness and subjective well-being, steeper declines in perceived stress and higher levels of hope and empathy after one year.

Practical Implications

MBSR participants fared better overall than the waitlist controls, indicating that trait mindfulness is not necessary to benefit from MBSR. However, individuals entering an MBSR intervention with higher levels of trait mindfulness are more likely to experience significant changes in multiple psychological domains. 

Clinicians may wish to assess their client’s level of trait mindfulness in order to better predict the extent to which he or she will benefit from the program.

Additional resources about mindfulness

The following websites contain more information about practicing mindfulness outside of a formal MBSR intervention setting. Interested psychologists may download and use many of the documents and handouts with clients or to practice developing their own mindfulness.

  • What are the benefits of mindfulness?
    A 2012 article from the APA Monitor by Daphne M. Davis, PhD, and Jeffrey A. Hayes, PhD, which includes information about the empirically supported benefits of mindfulness, the effects of meditation on therapists, therapist trainees and their clients, and important next steps in mindfulness research.
  • The Center for Contemplative Mind in Society
    Basic, self-guided instructions for mindfulness meditation written by Steven Smith, an advisor at the Center for Contemplative Mind in Society, a secular non-profit organization focused on increasing contemplation and compassion in the world.
  • Mindful Awareness Research Center
    Free, guided meditations (podcasts), ranging in length from 3-19 minutes and focused on various aspects of meditation.
  • Dharma Realm Buddhist Young Adults (PDF, 563KB)
    Instructions for self-guided mindful awareness of breathing from the Dharma Realm Buddhist Young Adults (DRBY), a California-based group interested in applying Buddhist principles to their daily lives.