On the porosity of subject and object in ‘mindfulness’ scientific study: challenges to ‘scientific’ construction, operationalization and measurement of mindfulness

Aspects of acceptance: building a shared conceptual understanding

Many contemplatives, scientists, and clinicians have pointed to the value of responding to life's difficulties by accepting experiences as they are. A growing body of research also suggests that acceptance contributes to effective coping with adversity, reduced stress, and improved emotional well-being. Yet within the scientific literature, there is little consensus on what acceptance means or how it should be measured. This makes it nearly impossible to synthesize empirical work on acceptance into a cohesive scientific understanding. Our goal in this paper is to clarify four facets of acceptance that are commonly referenced in research: acknowledging, allowing, non-judging, and non-attachment. We do not propose a specific definition of acceptance or even a set of privileged facets that must be included in future frameworks. We instead offer a vocabulary to facilitate productive communication among researchers that will, in turn, enable a more definitive scientific understanding of this important construct to emerge. After defining and explaining these aspects of acceptance, we further clarify these constructs in two ways. First, we illustrate how the four aspects are dissociable from one another. Second, we analyze their correspondence to related constructs from Acceptance and Commitment Therapy (ACT). Finally, we provide a concept worksheet that scholars can utilize to precisely operationalize acceptance in their own work.

Mindfulness in paediatric occupational therapy practice: a phenomenological inquiry

PURPOSE

While research into mindfulness practices is on the rise across populations, there is evidence to suggest that clinical practice has outpaced the literature with regard to mindfulness in pediatric rehabilitation. The aim of this study was to explore the perceptions of occupational therapists who opt to incorporate mindfulness into their clinical practices with children and youth.

METHODS

Hermeneutic phenomenology was the methodology of the study. The theoretical framework employed a Heideggerian-informed phenomenology of practice. Eight occupational therapists practicing in Canada and the United States participated in 90-120 min semi-structured interviews that elicited first-hand accounts of mindfulness in pediatric occupational therapy practice. Interviews were transcribed verbatim and analyzed using Finlay's four-step approach.

RESULTS

Six salient themes were identified in the data: drawing from personal practice, enhancing participation, fostering healthy habits, adapting for children, keeping it playful, and doing with.

CONCLUSION

The findings of this study offer insights for therapists who are considering incorporating mindfulness into their practices with children and youth. Further, this research highlights a number of research priorities that require further inquiry.

Testing the monitor and acceptance theory: the role of training-induced changes in monitoring- and acceptance-related capacities after attention-based, socio-emotional, or socio-cognitive mental training in reducing cortisol stress reactivity

Mindfulness-based interventions have become a popular means to reduce stress. However, the specific mechanisms driving observed stress reduction remain understudied. The Monitor and Acceptance Theory suggests that the cultivation of monitoring and acceptance skills are necessary moderators of practice-induced stress reduction. In the context of the ReSource Project, a large healthy adult sample underwent three 3-month mental training modules targeting either attentional (Presence module), socio-affective (Affect module) or socio-cognitive skills (Perspective module). In the current study, the development of a range of inter-individual differences in mindfulness-, interoception- and compassion-related traits - which mapped to either monitoring or acceptance categories - was tracked. The relationship of these training-induced changes with cortisol stress reactivity after the three distinct 3-month training modules was explored. We found that stress sensitivity was particularly modulated by a differential adaptivity of one cultivated attentional capacity - Attention regulation - which predicted higher cortisol reactivity after mere attention training (Presence) but was associated with lower stress-induced cortisol release after additional socio-affective and socio-cognitive practice (Affect and Perspective). However, this effect did not survive multiple comparisons correction, and analyses were limited by the sample size available. We conclude that our study provides preliminary support of the Monitor and Acceptance Theory, lending weight to the advantage of primary attentional increases in order to fully harness the beneficial effects of socio-affective training, ultimately leading to stress reduction. Although training-induced increases in acceptance were not directly shown to contribute to lowering cortisol stress reactivity, the data suggest an additional benefit of socio-affective and socio-cognitive training that is not directly captured within the current analyses. Our study corroborates the importance of going beyond the training of attention monitoring to foster stress resilience, and highlights that mental training relies on the co-development of several interacting processes to successfully attenuate stress. Further exploring the overarching concept of acceptance in future research may prove beneficial to the theoretical framework of MAT, and in understanding the processes by which stress reduction occurs.

Features of Self-Organization during the Process of Mindfulness-Based Stress Reduction: A Single Case Study

Compared to the extensive evidence of the effectiveness of mindfulness-based interventions, there is only a limited understanding of their mechanisms of change. The three aims of this study are (1) to identify features of self-organization during the process (e.g., pattern transitions), (2) to obtain an impression of the effects of continuous self-assessments and feedback sessions on mindfulness-related stress reduction, and (3) to test the feasibility of high-frequency process monitoring and process feedback. Concerning aim (1), the specific hypothesis is that change will occur as a cascade of discontinuous pattern transitions emerging spontaneously in the sense of not being a reaction to external input. This single case study describes changing patterns of multiple time series that were produced by app-based daily self-assessments during and after an 8-week mindfulness-based stress reduction program. After this MBSR program, the participant (a female nurse) continued the self-assessment and the mindfulness practice for a further 10 months. The results confirm findings on the positive effects of mindfulness programs for healthcare professionals, especially on coping with work-related stress. The analysis of the time series data supports the hypothesis of self-organization as a possible mechanism of change manifesting as a cascade of phase transitions in the dynamics of a biopsychosocial system. At the end of the year, the participant reported a beneficial impact of daily monitoring and systematic feedback on the change process. The results underline the feasibility and usefulness of continuous high-frequency monitoring during and after mindfulness interventions.

Mindful eating: A conceptual critical review of the literature, measurement and intervention development

Background: Defining mindful eating and discussing all it entails has proven to be abstract, open-ended and biased to the interpretation of the researchers and authors in the field. Despite some consensus, different interpretations have led to different psychometric tools and practices not descriptive of mindful eating, contributing towards a replication crisis. Aim/Method: This narrative review will draw on the most appropriate definition of mindful eating in the framework of traditional secular mindfulness literature and discuss how mindful eating psychometrics and practices are unsuitable for precise research. Results/Discussion: A proposal and directive of separation between eating behaviours and decision-making in mindful eating as a way of developing evidence-based practices and psychometric tools are proposed for both clinical and non-clinical use.

Ecological Momentary Assessment Of State Fluctuations In Mindfulness And Symptoms In Psychotic Disorders

Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; n = 49) and healthy controls (CN; n = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.

Negative Bias or Positive Deficiency, or Both? The Relationship Between Individual Authenticity and Depression Among Preschool Teachers: The Sequential Mediation Effects of Mindfulness and Self-Alienation

Objective

Depression has become a topic of widespread concern around the world, and teachers' depression has also had an important impact on the healthy development of education. However, there are differences in the cognitive theory of depression and positive psychology about the mechanism of depression. This study attempts to verify the related viewpoints of the two viewpoints through empirical research.

Methods

Three hundred and twenty eight preschool teachers were measured with authenticity scale, five facet mindfulness questionnaire, center for epidemiologic studies depression scale, and general alienation scale.

Results

Individual authenticity negatively predicted depression. Mindfulness can mediate the relationship between individual authenticity and depression. Self-alienation mediates the relationship between individual authenticity and depression. In addition, mindfulness and self-alienation played a sequential mediating role between individual authenticity and depression.

Conclusion

Mindfulness and self-alienation play a sequential mediating role between individual authenticity and depression. This study not only confirms the relevant theoretical viewpoints of positive psychology on depression, but also believes that individual depression is not only affected by one's own negative bias but also by one's own positive factors. At the same time, the individual's own positive factors will affect the negative factors. This perspective will provide new literature references to existing relevant theories about depression. In addition, this study will also provide literature reference for early childhood education practice.

Mindfulness-based stress reduction increases stimulated IL-6 production among lonely older adults: A randomized controlled trial

Loneliness is a potent psychosocial stressor that predicts poor health and mortality among older adults, possibly in part by accelerating age-related declines in immunocompetence. Mindfulness interventions have shown promise for reducing loneliness and improving markers of physical health. In a sample of lonely older adults, this two-arm parallel trial tested whether mindfulness training enhances stimulated interleukin-6 (IL-6) production, a measure of innate immune responsivity. Lonely older adults (65-85 years; N = 190) were randomized to an 8-week Mindfulness-Based Stress Reduction (MBSR) or control Health Enhancement Program (HEP) intervention. Lipopolysaccharide (LPS)-stimulated production of IL-6 was measured in vitro by blinded outcome assessors at pre-intervention, post-intervention, and 3-month follow-up. Mixed-effects linear models tested time (pre, post, follow-up) by condition (MBSR vs. HEP) effects. As predicted, a significant time × condition effect on stimulated IL-6 production was observed across pre, post, and follow-up timepoints. Significant MBSR vs. HEP differences emerged from pre- to post-intervention (p =.009, d = 0.38) and from pre-intervention to 3-month follow-up (p =.017, d = 0.35), with larger increases in IL-6 production following MBSR compared to HEP. No study-related adverse events were reported. Results show that mindfulness training may be effective for boosting innate immunocompetence among lonely older adults. Given that immunocompetence tends to decline with age, mindfulness training may help to counteract the effects of aging and psychosocial stress on infection risk and recovery from injury.

Meditators' Non-academic Definition of Mindfulness

Objectives

Mindfulness has been defined differently in academic scientific contexts and in Buddhist academic contexts. An under-studied area is that of lay (non-academic) theories of mindfulness. The goal of this article is to identify, organize, analyze in detail, and provide themes from the meditators' definitions of mindfulness. Possible differences and similarities of the collected definitions of mindfulness with the scientific-academic definitions and with the academic-Buddhist definitions are also checked.

Methods

A qualitative and inductive thematic analysis on the definitions of mindfulness offered by the participants was carried out.

Results

The sample consisted of 326 meditators who offered a definition of mindfulness through an open question. Seven themes were identified: (1) mindfulness defined as attention/awareness; (2) mindfulness defined as a non-evaluative attitude; (3) mindfulness defined as strategy; (4) mindfulness defined from a theoretical analysis; (5) mindfulness defined as a psycho-affective-spiritual state; (6) mindfulness defined as personal development; and (7) lack of understanding of mindfulness. From these themes, it can be deduced that the definitions collected share more patterns of meaning with the scientific-academic definition of mindfulness than with the academic-Buddhist one.

Conclusions

The findings of this study provide new insights into the complexity and heterogeneity of the definition of mindfulness. What has been discovered may indicate the complexity of the mindfulness construct itself.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01899-3.

Meditation experience is associated with lower levels of repetitive negative thinking: The key role of self-compassion

The primary aim of this study was to investigate the relationship between meditation experience and repetitive negative thinking (RNT) in regular meditators with a wide range of experience, and to examine the extent to which self-compassion and mindfulness mediate this relationship. RNT is a transdiagnostic process that is implicated in the development and maintenance of several mental health disorders. Converging evidence suggests that meditation practice is associated with improved mental health and may reduce levels of RNT. Increased levels of self-compassion and mindfulness have been associated with decreased levels of RNT and proposed as theoretically consistent mediators by which meditation practice exerts its beneficial effects; however, they are seldom considered in combination. In a cross-sectional design, 1281 meditators (mean age = 44.7 years, SD = 13.9, 53.7% female) completed questionnaires about meditation experience, RNT, self-compassion, and mindfulness. Linear regression and generalised structural equation models were used to examine the data. Longer duration of meditation experience was associated with lower levels of RNT and higher levels of self-compassion and mindfulness. Meditation experience was associated with RNT indirectly through self-compassion, but not through mindfulness. The results offer preliminary support for longer-term meditation as a potential means for reducing the maladaptive process of RNT. Clinically, self-compassion could be identified as a promising treatment target for interventions.

How do people conceptualize mindfulness?

While the concept of mindfulness is ubiquitous, its meaning is ambiguous, with limited knowledge about how it is understood by the general public. Understanding how laypeople perceive mindfulness and mindful people is vital, as it will impact how people interpret and act upon information about mindfulness and mindfulness practices. Study 1 participants evaluated the term mindfulness positively, while Study 2 participants perceived a mindful target positively and as strongly endorsing self-transcendence values (e.g. equality). Study 3 participants learned about an unknown target who was mindful or not. The mindful target was evaluated more positively than the less-mindful target and seen as endorsing different values. Most effects in Studies 1-3 were stronger among more mindful participants. Study 4 assessed visual representations of mindful and less-mindful faces. Visual representations of a mindful face were judged by naive raters as more likeable, possessing higher self-transcendence values and performing more moral behaviours compared with a less-mindful face. The results suggest that how people interpret mindfulness has important consequences and can be used to guide how mindfulness is implemented in response to global challenges.

Investigating mindfulness influences on cognitive function: On the promise and potential of converging research strategies

Research investigating the effects and underlying mechanisms of mindfulness on cognitive functioning has accelerated exponentially over the past two decades. Despite the rapid growth of the literature and its influential role in garnering public interest in mindfulness, inconsistent methods in defining and measuring mindfulness have yielded variable findings, which contribute to the overall dearth of clear generalizable conclusions. The focus of this article is to address the lack of cohesion in the collective methodologies used in this domain by providing a new perspective grounded in classic cognitive and experimental psychology principles. We leverage the concept of converging operations to demonstrate how seemingly disparate research strategies can be integrated towards a more unified and systematic approach. An organizing taxonomic framework is described to provide useful structure in how mindfulness can be operationalized, measured, and investigated. We illustrate the rationale and core organizing principles of the framework through a selective review of studies on mindfulness and cognitive control. We then demonstrate the utility of the approach by showing how it can be applied to synthesize extant methodologies and guide the development of future research. Specific suggestions and examples pertaining to experimental design and statistical analysis are provided.

First, do no harm: An intensive experience sampling study of adverse effects to mindfulness training

OBJECTIVE

The study of safety and adverse effects of mindfulness-based interventions (MBIs) is limited. We propose a novel reliable change index (RCI) approach to experience sampling (ES) data to begin to understand the common domains, frequency, severity, risk for, and context of adverse responding to mindfulness meditation practice and brief MBI.

METHODS

Over the course of a 21-day MBI among 82 meditation-naïve participants, we estimated (i) momentary adverse effects during mindfulness meditation practice and (ii) sustained adverse effects in daily living following the intervention.

RESULTS

First, RCI analyses of experience sampling of mindfulness meditation document that 87% of participants demonstrated at least one momentary adverse effect during meditation, most commonly anxiety; and subject-level temporal variability or instability in experience samples of daily living did not account for momentary adverse effects attributed to mindfulness meditation sessions. Second, 25% of participants experienced a sustained adverse effect in daily living at post-intervention. Yet, neither momentary adverse effects to meditation nor vulnerability factors at pre-intervention predicted adverse effects at post-intervention.

CONCLUSIONS

Findings illustrate that mindfulness meditation may be transiently anxiogenic for many participants, yet, these experiences are unlikely to constitute objective harm per se. Furthermore, observed deterioration in daily living post-intervention cannot be attributed to momentary adverse effects in response to mindfulness meditation. We speculate that observed deterioration in daily living post-intervention may thus be better explained by increased awareness to internal states following mindfulness training. Findings highlight the potential utility of applying a RCI approach to intensive ES measurement to quantify adverse effects of mindfulness training specifically and mental health interventions broadly.

Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Mindfulness-Meditation Program Among Older Adults

BACKGROUND AND OBJECTIVES

Few studies have focused on the utility of mindfulness-meditation for well-being in older adults. The present study investigated the feasibility, acceptability, and preliminary efficacy of an app-based mindfulness-meditation program among older adults.

RESEARCH DESIGN AND METHODS

A community-based sample of 46 participants aged between 63 and 81 (M = 70.85, SD = 4.70) engaged with a 30-day app-based mindfulness-meditation program for 10 min daily on their smartphones. Each meditation session comprised focusing on the breath, mentally scanning the body, monitoring the mind's activity, and cultivating a nonjudgmental orientation toward experiences. Participants completed questionnaires at baseline, day 10, and day 30.

RESULTS

On average, participants completed 25 sessions and almost 4 h of application use across the 30 days. Results of linear mixed effects models showed significant improvements in positive affect, negative affect, and life satisfaction across the study interval, but no meaningful change in total mindfulness or perceived stress. Furthermore, relative to high levels of smartphone efficacy, low smartphone efficacy was associated with higher perceived stress and negative affect, and less life satisfaction at baseline; and steeper improvements on these outcomes across the study interval. On average, older adults rated the app-based mindfulness-meditation training as interesting, enjoyable, valuable, and useful.

DISCUSSION AND IMPLICATIONS

The findings provide preliminary support for the feasibility and acceptability of an app-based mindfulness-meditation program with community-dwelling older adults and demonstrate potential benefits for well-being. Results suggest the value of further research investigating the efficacy of digital mindfulness-meditation interventions for older adults via larger randomized controlled trials.

The Role of Mindfulness in the Intimate Relationships and Psychological Wellbeing in Emerging Adulthood

Little is known about the impact of mindfulness on psychological wellbeing, anxiety, and avoidance in couple relationships. In emerging adulthood, intimate relationships are associated with life satisfaction and changes that can cause psychological maladjustment. This study seeks to determine if dispositional mindfulness acts as a protective variable between psychological wellbeing, anxiety, and avoidance and identify the factors that are protectors. A sample was obtained of 391 young university students between 18 and 25 years old. The Five-Facet Mindfulness Questionnaire, the Ryff Scales of Psychological Wellbeing, and the Experiences in Close Relationships Scale were used. The results show that the highest levels of dispositional mindfulness are associated with greater psychological wellbeing. Dispositional mindfulness cannot act as a protective variable against anxiety and avoidance, and values were non-significant in intimate relationships. It is necessary to continue investigating the most protective facets of mindfulness for both anxiety and avoidance.

Older and more mindful? Age differences in mindfulness components and well-being

OBJECTIVES

Empirical research on the processes through which mindfulness affects well-being is in its infancy. Furthermore, few studies have considered the positive effects of mindfulness on psychological functioning from a lifespan perspective. The present study aimed to examine the role of age in moderating associations of mindfulness components with well-being in the context of a proposed model of mindfulness.

METHODS

A community-based sample of 623 participants aged between 18 and 86 years (M = 48.78, SD = 16.74) was recruited via an internet-based research platform. Participants completed questionnaire measures of mindful characteristics (i.e. present-moment attention, nonjudgment, interoception, acceptance, nonattachment, and decentering), flexible goal adjustment, and well-being.

RESULTS

Parallel mediation analyses showed that both present-moment attention and nonjudgment provided significant pathways to (a) flexible goal adjustment through nonattachment and decentering; and (b) well-being through acceptance, nonattachment, and decentering. Furthermore, present-moment attention, nonjudgment, acceptance, nonattachment, and decentering were all positively associated with age. Conditional process analyses revealed that the direct relationships between (1) present-moment attention and well-being, (2) nonjudgment and well-being, and (3) decentering and flexible goal adjustment became stronger with age and were significant for adults from around 40 years of age and older.

CONCLUSIONS

The findings suggest that the tendency to focus on the present-moment and adopt a nonjudgmental orientation may become especially important for well-being with advancing age, and the ability to appreciate the transitory nature of personal experiences may be particularly important for flexible employment of both goal disengagement and reengagement strategies across the second half of life.

Mindfulness Buffers the Effect of Inauthenticity on Depression

OBJECTIVES

Pressures in daily life limit one's ability to be authentic and research shows that inauthenticity can be detrimental to mental health. Mindfulness is known to have a protective effect on mental health through an accepting and nonjudgmental stance. This study aimed to establish whether mindfulness buffers the relationship between inauthenticity and depression.

METHOD

A cross-sectional sample of employed individuals in New Zealand (n=301) completed an online survey assessing their levels of authenticity, mindfulness, and depression.

RESULTS

Findings indicate that authenticity and mindfulness together explain 29% of variance in depression. In addition, mindfulness can buffer the negative impact of low authenticity on depression.

CONCLUSION

Inauthenticity is related to higher levels of depression, but mindfulness is able to buffer this impact. These findings imply that engaging in mindfulness practice may be beneficial for mental health when individuals experience reduced authenticity.

Not all types of meditation are the same: Mediators of change in mindfulness and compassion meditation interventions

BACKGROUND

The general aim of the study was to examine the relative effectiveness and mediators of change in standardized mindfulness and compassion interventions.

METHODS

A sample of 431 participants enrolled in a Mindfulness-Based Stress Reduction program (MBSR = 277) and a Compassion Cultivation Training (CCT = 154). The assessment before and after the program included a set of outcomes and mediators measures. A three-step data analysis plan was followed: ANCOVAs, Reliable Change Index, and mediations (simple and multiple).

RESULTS

Both interventions yielded increased mindfulness, decentering, body awareness, and self-compassion. Yet, present-moment awareness improvements (i.e., decentering, and body awareness) were significantly larger in the MBSR than in CCT, whereas socio-emotional changes (i.e., common humanity and empathic concern) were larger in the CCT than in MBSR. The magnitude of effect sizes ranged from medium to large. Furthermore, both mindfulness and compassion interventions yielded similar changes in psychological distress (i.e., stress, anxiety, and depression), maladaptive cognitive processes (i.e., rumination and thought suppression), and well-being. The mediation models showed that although the MBSR program seemingly relies on changes in present-moment awareness mechanisms (i.e., decentering and body awareness) to reduce psychological distress and to improve well-being, the CCT program seemingly achieves the same positive outcomes through changes in socio-emotional mechanisms (i.e., common-humanity and empathy concern).

LIMITATIONS

Due to our naturalistic design in real-world community setting, it was infeasible to randomly assign participants to conditions.

CONCLUSIONS

Our results suggest that mindfulness and compassion programs operate through different pathways to reduce psychological distress and to promote well-being.

Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness

BACKGROUND

Irritable bowel syndrome (IBS) is a common and often debilitating chronic gastrointestinal disorder characterized by abdominal pain and altered bowel habits. Pharmacological treatments are often ineffective, leading to the development of a variety of behavioral interventions. Mindfulness-based stress reduction (MBSR) is one such program that has shown efficacy in reducing gastrointestinal (GI) symptoms and improving quality of life (QOL). This single-arm intervention study examines the association of clinical outcomes with changes in specific aspects of mindfulness.

METHODS

Adults with IBS (53 women, 15 men) participated in an 8-week MBSR class. Primary outcomes of GI symptom severity, quality of life, and GI-specific anxiety, as well as specific aspects of mindfulness using the Five Factor Mindfulness Questionnaire (FFMQ), were assessed at baseline, post-treatment, and 6-month follow-up.

KEY RESULTS

Gastrointestinal symptom responder rate was 71%, and there was a significant pre-post treatment change for three of the five FFMQ scales. Regression analysis indicated that change in the Act with Awareness (P = .02) facet of mindfulness was the strongest predictor of GI symptom and QOL improvement.

CONCLUSIONS & INFERENCES

Mindfulness-based stress reduction training was associated with robust improvements in GI symptoms and associated problems in participants with IBS. Although significant increases in 3 of the 5 measured facets of mindfulness were found, regression analyses suggest that increases in the ability to retain present moment focus and act with awareness may be particularly important for improving outcomes in individuals with IBS. These results may inform the refinement of mindfulness-based protocols specifically for treatment of IBS.

The Adoption of New Treatment Modalities by Health Professionals and the Relative Weight of Empirical Evidence in Favor of Virtual Reality Exposure Versus Mindfulness in the Treatment of Anxiety Disorders

Anxiety disorders are among the most prevalent mental disorders, and cognitive-behavioral therapy (CBT) with exposure exercises is considered as the gold-standard psychological intervention. New psychotherapeutic modalities have emerged in the last decade and, among them, mindfulness has been rapidly adopted by therapists. The adoption rate is slower for the use of virtual reality (VR) to conduct exposure. The goal of the present position paper is to contrast, for the treatment of anxiety disorders, the weight of empirical evidences supporting the use of exposure in VR with the use of mindfulness-based therapy (MBT). Based on the most recent meta-analyses, we found that CBT with exposure conducted in VR was more thoroughly researched and supported than MBT, receiving validation from roughly twice as many studies with high control (i.e., randomized, active controls with clinical samples). However, this conclusion is nuanced by reviewing gaps in the literature for both therapies. Potential factors influencing clinicians' choice of treatment and suggestions for future research directions are proposed.

Mindfulness, Interoception, and the Body: A Contemporary Perspective

Mindfulness is often used as an umbrella term to characterize a large number of practices, processes, and characteristics. Critics argue that this broad definition has led to misinformation, misunderstanding, and a general lack of methodologically rigorous research. Some of the confusion surrounding mindfulness is also believed to stem from an undifferentiated use of the term mindfulness and meditation. Mindfulness and all other forms of meditation have been shown to modulate the insula, which is the primary hub for interoception. Some have argued that interoception is foundational to mindfulness and may be the primary mechanism by which one benefits from the practice. However, much like the mindfulness literature, interoception remains broadly defined often without precision and with domain-specific meanings and implications. Research demonstrates that the insula and surrounding neural circuits are believed to be responsible for a number of other functions beyond interoception including attention, awareness, and all subjective experiences, much of which has been linked to the mindfulness literature. It has been assumed that mindfulness produces these neuroplasticity and functional effects. There is evidence that mindfulness and some of its benefits may be better described as increased interoception as a result of the neuroplasticity changes in the insula, and the development of the insula and surrounding neural circuits may cultivate dispositional mindfulness. The purposes of this article are to (1) highlight that it may be more accurate to link many of the identified benefits in the mindfulness literature to interoception and its neurological correlates and (2) propose attentional style as a means to clarify some of the confusion surrounding mindfulness, interoception, and meditation. Different meditations require different attentional styles. Attention can be analogous to a focal point with each focal point providing a unique perspective. Given that all meditative techniques modulate the insula, each meditation can provide a unique perspective from which to investigate complex interoceptive signals that may be unavailable from other meditative traditions. It may prove more useful to anchor scientific findings in the concrete body as a means to investigate those rather than a set of abstract, broadly defined meditative techniques.