What are the Active Ingredients of Mindfulness-based Interventions?

What are the Active Ingredients of Mindfulness-based Interventions?

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Mindfulness-based interventions typically comprise numerous elements, including some or all of the following: guided mindfulness exercises, guided loving-kindness and compassion meditation exercises, group discussion, psycho-education (sometimes in the style of a university lecture), yoga, one-to-one discussion with the programme facilitator, a CD of guided meditations to encourage at-home practice, and a full or half-day silent group retreat. Given that each of the above techniques arguably have therapeutic utility in their own right, ascertaining why MBIs are effective is problematic because they have numerous ‘active ingredients’.

Not controlling for other active ingredients is a common limitation of MBI intervention studies. Indeed, although scientific evidence demonstrates that certain MBIs are equally or more effective than other treatments for improving specific health conditions, it is currently unclear whether it is mindfulness, or mindfulness in combination with other therapeutic techniques, that results in health benefits. One way to overcome this methodological limitation is to employ a purpose-designed ‘active’ control condition. This is a control intervention that mirrors the main intervention in terms of its design, but does not include any mindfulness techniques. By conducting a randomised controlled trial that compares the effectiveness of an MBI against a suitably formulated active control intervention, we can determine that superior outcomes in the MBI versus control group are caused by mindfulness.

It could be argued that it doesn’t matter whether it is specifically mindfulness or other intervention components that make MBIs effective. If we are only interested in treatment outcomes and adhere to a ‘what works’ approach to alleviating illness symptoms, then establishing which intervention components are most effective becomes less important. However, from the point of view of advancing scientific understanding of how the human mind reacts to given psychotherapeutic techniques, it is useful to establish which ingredients are most active within a given intervention. Such knowledge can also help to inform the development of more effective and ‘therapeutically streamlined’ MBIs.

When designing an active control intervention for MBI efficacy studies, in addition to matching the design of the target and control interventions (i.e., minus the inclusion of mindfulness techniques), it is also important to match the ‘competency’ of the instructor or instructors delivering the two interventions. For example, a number of meditation intervention studies employing an active control condition have used an experienced clinician and meditation teacher to deliver the MBI, whilst leaving a relatively inexperienced student to administer the control intervention. Clearly, such an approach can introduce bias and weaken the strength of the evidence from MBI studies.

In order to overcome the above methodological limitation, in a recent randomised controlled trial that we conducted, the study was designed such that the same instructor delivered the MBI and comparison intervention. To control for potential bias on the part of the instructor, participants in each intervention condition were asked to rate the instructor’s levels of enthusiasm and preparation. Statistical tests were then performed to determine if there were significant differences between how participants from the intervention and control group rated the instructor’s performance.

We decided to control for an ‘instructor effect’ because in our opinion, the mindfulness instructor is one of the most active ingredients in MBIs. Part of our research has involved the development and empirical investigation of a ‘second-generation’ of MBI. Second-generation MBIs (such as Meditation Awareness Training) are designed slightly differently compared to ‘first-generation’ MBIs (such as Mindfulness-based Stress Reduction or Mindfulness-based Cognitive Therapy). More specifically, second generation MBIs are overtly spiritual in nature and teach a greater range of meditative techniques. Given that second-generation MBIs comprise different design elements compared to first-generation MBIs, it is reasonable to assume that these two types of MBIs will result in different outcomes. However, despite the design differences between first- and second-generation MBIs, it is our view that if a mindfulness teacher with authentic spiritual realisation was to administer a first-generation MBI, the outcomes would be very similar to them administering a second-generation MBI.

In other words, if the mindfulness teacher is genuinely rooted in the present moment, the specific design of the MBI becomes less important. As we discussed in our post on The Four Types of Psychologist, we would argue that the same principle applies to the majority of psychological therapies. If the clinician knows their own mind, has genuine compassion for the client, and is skilled in helping the client understand their problems, then the choice of therapy becomes less important.

Although preliminary findings (including from some of our own clinical case studies and qualitative studies) support the notion that the mindfulness teacher is one of the (if not the) most important ingredients of MBIs, there is clearly a need for further research investigating how the instructor influences outcomes. However, in the absence of extensive empirical investigation into this subject, we hypothesise that what participants of MBIs need most (and therefore respond best to), is the unconditional love and spiritual wisdom of a teacher who is without a personal agenda, and whose mind is saturated with meditative awareness.

 

Ven. Edo Shonin and Ven. William Van Gordon

Further Reading

Baer, R., Smith, G., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27-45.

Chiesa, A. (2013). The difficulty of defining mindfulness: Current thought and critical issues. Mindfulness, 4, 255-268.

Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67, 404-424.

MacCoon, D., Imel, Z., Rosenkranz, M., Sheftel, J., Weng, H., Sullivan, J., . . . Lutz, A. (2012). The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behavior Research and Therapy, 50, 3-12.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N. N., & Griffiths, M. D. (2014). Meditation Awareness Training for work-related wellbeing and job performance: A randomised controlled trial. International Journal of Mental Health and Addiction, 12, 806-823.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015a). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

Author: Dr Edo Shonin & Ven William Van Gordon

Dr Edo Shonin Dr Edo Shonin is research director of the Awake to Wisdom Centre for Meditation and Mindfulness Research, and a chartered psychologist at the Nottingham Trent University (UK). He sits on the editorial board for the academic journal Mindfulness and the International Journal of Mental Health and Addiction. Edo is internationally recognised as a leading authority in mindfulness practice and research and has over 100 academic publications relating to the scientific study of meditation and Buddhist practice. He is the author of ‘The Mindful Warrior: The Path to Wellbeing, Wisdom and Awareness’ and primary editor of academic volumes on ‘The Buddhist Foundations of Mindfulness’ and ‘Mindfulness and Buddhist-derived Approaches in Mental Health and Addiction’. He has been a Buddhist monk for thirty years and is spiritual director of the international Mahayana Bodhayati School of Buddhism. He has also received the higher ordination in the Theravada Buddhist tradition. Edo regularly receives invitations to give keynote speeches, lectures, retreats and workshops at a range of academic and non-academic venues all over the world. Ven William Van Gordon Ven William Van Gordon has been a Buddhist monk for almost ten years. He is co-founder of the Awake to Wisdom Centre for Meditation, Mindfulness, and Psychological Wellbeing and the Mahayana Bodhayati School of Buddhism. He has been ordained within Hinayana, Mahayana, and Vajrayana Buddhist traditions and has extensive training in all aspects of Buddhist practice, psychology, and philosophy. Prior to becoming a Buddhist monk, Ven William Van Gordon worked for various blue chip companies including Marconi Plc, PepsiCo International, and Aldi Stores Limited where he worked as an Area Manager responsible for a multi-site £28 million portfolio of supermarkets with over 50 employees. Ven William Van Gordon is also a research psychologist and forms part of the Psychological Wellbeing and Mental Health Research Unit, Psychology Division, Nottingham Trent University. His area of research expertise is the study of ‘authentic spiritual transmission’ – within mainstream Buddhism itself as well as within contemporary Buddhist-derived clinical interventions. His current research projects are concerned with evaluating the effectiveness of meditation and mindfulness for the treatment of various health conditions. Ven William Van Gordon has numerous publications relating to the clinical utility of meditative interventions including in leading peer-reviewed psychology journals. As a separate undertaking, William is currently writing-up his doctoral thesis which relates to the effects of meditation on work-related wellbeing and performance. Ven William Van Gordon enjoys fell running, martial arts, DIY, reading and writing poetry, caring for cancer patients, and studying civil litigation. He is a keen mountaineer with some arctic expedition experience.

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