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Mindfulness

Author: Dr Simon Moss

Overview

Individuals who often experience some emotion or pain, but are oblivious to this feeling or discomfort until some time later, frequently engage in tasks without really being aware of their behavior, and tend to reflect upon the past or plan the future instead of attending to ongoing activities are less likely to feel satisfied with life and experience a sense of wellbeing (Brown & Ryan, 2003). The concept of mindfulness can explain this observation.

Mindfulness refers to a psychological state in which individuals experience an awareness of objects in their immediate environment as well as their current thoughts and feelings (Brown & Ryan, 2003). When eating a meal, for example, they direct their attention to the immediate tastes as well as feel aware of their increasing sense of satiation, even distention of the stomach (Brown & Ryan, 2003).

Because their attention is directed to immediate--not past or future--experiences, these objects, thoughts, and feelings are perceived accurately, devoid of bias and distortions (Brown & Ryan, 2004b). In addition to curbing bias, this diversion of attention from the past ensures that reactions to events are adaptive not automatic or rote sequences of actions (Bishop, Lau, Shapiro, Carlson, Anderson, et al., 2004).

Definition

Individuals who demonstrate mindfulness direct their attention to their present surroundings and their psychological state, but engage in experiential rather than analytical processing. That is, mindfulness refers to sustained or frequent awareness and attention to current and ongoing experiences.

Hence, mindfulness departs from other forms of awareness, such as rumination, self monitoring, and need for cognition, all of which are characterized by analytical, logical, rational forms of processing information (Brown & Ryan, 2003). That is, unlike these other forms of awareness, mindfulness does not involve cognitive reflection and analysis.

More precisely, Germer (2005) defined the three interrelated constituents of mindfulness. First, mindfulness involves a sense of awareness. That is, individuals feel aware rather than hazy. Second, this awareness is directed to their ongoing experience. In other words, individuals feel aware of their immediate experiences and environment--and do not direct their attention to past events or future possibilities. Third, this awareness of ongoing experience does not involve any judgment, evaluation, and even elaboration (cf., Kabat-Zinn, 1994). That is, their thoughts, feelings, sensations, and urges are all accepted rather than judged.

The term mindfulness can be used in different contexts. That is, sometimes mindfulness refers to a description of some state-a state characterized as a sense of uncritical awareness of ongoing experience. Alternatively, mindfulness can represent an intervention, usually involving meditation, in which individuals learn how to evoke this state of awareness. Finally, mindfulness can be conceptualized as a mental process, rather than as a state, underpinning self regulation (Brown & Ryan, 2003) or acceptance (Linehan, 1994).

Dimensions of mindfulness

Some scholars have proposed that mindfulness might entail multiple, distinct facets or dimensions. Bishop (2002), for example, distinguishes between awareness of ongoing experiences and the absence of any judgment or evaluation of these experiences. Similarly, when various measures of mindful behaviors were subjected to a factor analysis, five dimensions emerged: level of awareness, judgment, reactivity, description, and observation. In contrast, other scholars have challenged these attempts to enumerate the facets of mindfulness, conceptualizing this state or process as a unified phenomenon (e.g., Ivanovski & Malhi, 2007).

In addition, Holzel, Lazar, Gard, Shuman-Olivier, Vago, and Ott (2011) differentiated four main processes that underpin mindfulness mediation: attention regulation, body awareness, emotional regulation--entailing both reappraisal and exposure--and change in self-perspective. Baer (2003) argued that five mechanisms underpin the benefits of mindfulness training: exposure, cognitive change, self-management, relaxation, and acceptance.

Evolution and history of mindfulness

Mindfulness ultimately emanated from Buddhist teachers. Nevertheless, several strands of research popularized the concept in psychological literature. For example, from a gestalt perspective, Perls (1973) contended that individuals form alienated, neglected, or biased memories of experience. In a relaxed state, individuals can convert these experiences into clear perceptions, which can be integrated into the self and promote wellbeing.

In the arena of psychology, mindfulness was first applied and evaluated formally within the context of an approach, characterized by Kabat-Zinn (1982), called Mindfulness Based Stress Reduction. Typically, the intervention lasts eight or so weeks and combines elements of mindfulness meditation and yoga. Individuals learn how to maintain awareness of their immediate environment and experiences, while accepting themselves unconditionally rather than judging critically. Techniques include the body scan, in which individuals become aware of the feelings and sensations in each part of their body. In addition, individuals learn how to integrate these techniques into everyday life. Improvements in symptoms lasting over 15 months have been demonstrated (Kabat-Zinn, Lipworth, & Burney, 1985)

Since this time, mindfulness has been incorporated into other paradigms. Specifically, mindfulness has been integrated with cognitive behavioral therapy, which evolved into an approach called mindfulness-based cognitive therapy (Segal, Williams, & Teasdale, 2002). Similarly, mindfulness is integral to acceptance and commitment therapy as well (Hayes & Wilson, 1994). Finally, dialectical behavior therapy, as delineated by Linehan (1993), also represents mindfulness mediation as one of the five key facets. This form of therapy was first designed to treat borderline personality disorder, involving emotional regulation.

In these paradigms, mindfulness meditation is assumed to be distinct from most alternative forms of meditation (see Lutz, Slagter, Dunne, & Davidson, 2008). In many traditional forms of meditation, individuals attempt to orient their attention towards a single entity: a candle, a word, an image, and so forth. They attempt to distract their attention from all other objects and thoughts. In mindfulness meditation, however, individuals attempt to maintain awareness on any ongoing mental experiences or events. They do not necessarily confine their attention to one specific object or thought-although inadvertent fixation is possible (Lutz, Slagter, Dunne, & Davidson, 2008).

Consequences

Mindfulness, which divorces individuals from their preconceptions and biases, might improve their capacity to regulate emotions effectively (Brown & Ryan, 2004a). Indeed, many studies have shown that training that is intended to facilitate mindfulness improves wellbeing (Kabat-Zinn, 1990& Shapiro, Schwartz, & Bonner, 1998& Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau, 2000).

Mindfulness is positively related to subjective wellbeing, life satisfaction, and self esteem, as well as inversely related to depression and anxiety (Brown & Ryan, 2003). These relationships tend to persist even after emotional intelligence, private self consciousness, neuroticism, and extraversion are controlled.

Benefits in clinical settings

A variety of studies have shown that attempts to instill mindfulness can alleviate mood disorders. That is, interventions that introduce or entail mindfulness have been shown to ameliorate symptoms of anxiety (Evans, Ferrando, Findler, Stowell, Smart, & Haglin, 2008), trauma (Follette, Palm, & Pearson, 2006) as well as depression (Kingston, Dooley, Bates, Lawlor, & Malone, 2007).

Nevertheless, the benefits of mindfulness are not confined to mood disorders. Such interventions have also been shown to curb psychosis (Bach & Hayes, 2002 & Gaudiano & Herbert, 2006), exhibitionism (Paul, Marx, & Orsillo, 1999), eating disorders (Telch, Agras, & Linehan, 2000), and other disorders. Furthermore, even physical conditions, such as chronic pain (Kabat-Zinn, 1982 & see also chronic pain), are amenable to the benefits of mindfulness.

Mindfulness is more likely to surface when individuals refrain from denying or suppressing previous failures and, therefore, tends to correspond to accurate rather than biased perceptions, promoting many benefits. Individuals who report a mindful disposition, for example, are less likely to exhibit pathological gambling because they do not overestimate the frequency of their victories-a common source of gambling problems (Lakey, Campbell, Brown, & Goodie, 2007).

Although these findings are certainly encouraging, not all of these studies establish whether a state of mindfulness does indeed mediate the benefits of these interventions. Conceivably, some other properties of these interventions, such as the novelty, could improve measures of wellbeing.

Defense mechanisms

Usually, when individuals are exposed to some consequential threat, a series of defense mechanisms are elicited. If they consider their own mortality, for example, they feel the need to defend their worldviews and collectives (see Terror management theory). Mindfulness has been shown to curb these defensive responses (Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, & Ryan, 2010).

For example, in one study, some participants were encouraged to consider their mortality. Furthermore, the extent to which American participants subsequently prefer presentations that vindicate, rather than question, their nation was assessed--a measure of worldview defense. If individuals reported elevated levels of trait mindfulness, the usual worldview defense in response to mortality salience diminished. That is, participants who maintain awareness of their feelings, sensations, and environment did not act as defensively in response to mortality salience (Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, & Ryan, 2010).

The final studies examined the mechanisms that underpinned these effects. Specifically, as these studies showed, when trait mindfulness was elevated, participants spent more time writing about their mortality. Thoughts about death were also more accessible in these individuals (Niemiec, Brown, Kashdan, Cozzolino, Breen, Levesque-Bristol, & Ryan, 2010). These findings indicate that participants did not evoke defense mechanisms to circumvent existential anxiety--that is anxiety about their inevitable mortality.

Impulsive behavior

As Papies, Barsalou, and Custers (2012) showed, mindfulness can diminish the desirability of temptations and, therefore, can reduce impulsivity (see self-control). Across a series of studies, some participants were subjected to a brief mindfulness intervention. They watched a sequence of pictures, including attractive foods. They were asked to monitor and observe the thoughts that each picture evoked. They were informed that such thoughts are merely responses to the pictures and are thus transient. These instructions were intended to highlight that thoughts are not equivalent to reality but are merely fleeting events. Other participants, in the control condition, received either no instructions or other instructions, depending on the study.

Next, participants completed a task that determines the extent to which they feel the need to approach desirable food. On each trial, either an attractive food item, such as pizza, or a neutral food item, such as raisins, appeared on a screen. Participants were told to press one button to shift the food away from them and one button to shift the food closer. The color of a frame around the food signaled whether they should shift the food away or closer.

In general, of course, participants were faster on trials in which they had to shift an attractive food item closer to them--because they tend to approach such foods. However, across all studies, if the participants had been subjected to the mindfulness intervention, this tendency diminished. They did not demonstrate this inclination to approach attractive foods to the same extent. This benefit of mindfulness was even observed after a five minute interval.

Emotional intelligence and wellbeing

According to Schutte and Malouff (2011), mindfulness might enhance emotional intelligence and thus improve wellbeing. Specifically, the key facets of mindfulness might promote emotional intelligence, defined as the capacity to identify, understand, utilize, and regulate emotions effectively. First, when individuals are mindful, their awareness is clear rather than hazy. They can, therefore, differentiate similar, but distinct, emotions such as dejection and anxiety, facilitating the development of emotional intelligence. Second, mindful individuals focus their attention on ongoing experiences, instead of the past and future. They may be, therefore, more sensitive to the gestures and mannerisms of people, enhancing their ability to decipher emotions. Finally, because they do not judge their experiences, they are more immune to biases, increasing the accuracy of their appraisals of emotions.

To assess this association between mindfulness and emotional intelligence, Schutte and Malouff (2011) conducted a study. Participants completed a measure of trait mindfulness. This measure assesses the extent to which individuals focus their attention on their ongoing experience, but without judgment. In addition, they completed a measure of emotional intelligence, designed to assess the capacity of individuals to identify, understand, harness, and manage emotions in both themselves and other people. Finally, a measure of wellbeing, including positive affect, negative affect, and life satisfaction, was administered.

Mindfulness was associated with these indices of wellbeing. Emotional intelligence partly or fully mediated these relationships. Although a cross-sectional study, these findings are consistent with the hypothesis that mindfulness enhances emotional intelligence. This emotional intelligence enables individuals to regulate emotions affectively, enhancing their wellbeing.

Self-esteem

Mindfulness has also been shown to enhance self-esteem. For example, in one study, conducted by Pepping, O'Donovan, and Davis (2013), participants completed the five facet mindfulness questionnaire. This instrument assesses the tendency of individuals to maintain awareness over their actions, rather than behave mindlessly, to describe or label their inner experiences, to refrain from judging their thoughts and feelings, to permit thoughts to enter their awareness without the need to suppress these experiences, and to observe their experiences. In addition, the individuals completed a measure of self-esteem. Besides observing experiences, all facets of mindfulness were positively associated with self-esteem.

In a subsequent study, Pepping, O'Donovan, and Davis (2013) showed that a short mindfulness intervention enhanced state self-esteem. That is, some participants completed a 15 minute intervention, in which they meditated on their breath and observed their thoughts without judging these experiences. In the control condition, participants read a story. The mindfulness intervention enhanced self-esteem.

These results can be explained by the possibility that mindfulness diminishes the intensity of negative thoughts. That is, individuals tend to react more forcefully to negative, rather than positive, thoughts and feelings about themselves. Describing these feelings, reducing judgment, permitting rather than suppressing these thoughts, and acting with awareness all diminish the likelihood these negative concerns will escalate uncontrollably. Individuals are not as likely to be consumed by negative thoughts about themselves, improving self-esteem.

Concentration and working memory

Mindfulness training has also been shown to enhance the capacity of people to excel on reading comprehension as well as enhance working memory. Fewer distractions mediate or underpin these benefits of mindfulness training (Mrazek, Franklin, Phillips, Baird, & Schooler, 2013).

Specifically, in the study conducted by Mrazek, Franklin, Phillips, Baird, and Schooler (2013), half the participants completed mindfulness training over two weeks. During each week, they completed four classes, each lasing 45 minutes. Participants sat on cushions in a circle in an upright position with their gaze lowered. For 10 to 20 minutes, they engaged in mindfulness exercises, in which they focussed their attention on a sensory experience such as their breath, tastes, or sounds. They shared their experiences with the class. They were then encouraged to distinguish between thoughts that arise naturally and elaborated thinking, reframe distracting thoughts as mental projections in the present, anchor their attention to their breath, exhale deliberately, and watch rather than suppress intrusive thoughts. Individuals were also encouraged to apply these practices to daily activities. In the control condition, participants completed training on nutrition instead over a similar timeframe.

A week later, participants completed a measure of reading comprehension and working memory. To assess working memory, sequences of 3 to 7 letters were presented verbally, and participants needed to repeat these sequences. Later, participants indicated the extent to which their mind wandered during these tasks. Mindfulness enhanced performance on these tasks and reduced mind wandering.

These findings are consistent with the notion that mindfulness diminishes activation of the default network--a collection of brain regions that are especially activated during rest rather than cognitive engagement. This network is also associated with mind wandering.

Creativity

Some but not all facets of mindfulness have been shown to enhance creativity (Baas, Nevicka, & Ten Velden, 2014). In particular, the capacity of individuals to observe and to orient their attention to many stimuli at the same time fosters this creativity. Other features of mindfulness, such as avoiding distractions, are not related or negatively related to creativity

For example, in one study, conducted by Baas, Nevicka, and Ten Velden (2014), participants completed a measure that gauges their capacity to maintain attention on their existing tasks rather than become distracted--one feature of mindfulness. In addition, to assess creativity, they were asked to identity all the possible uses of a brick. The capacity to maintain attention and avoid distractions was actually negatively associated with creativity, as measured by frequency of ideas, even after controlling conscientiousness and neuroticism.

In another study, participants completed a scale that gauges several facets of mindfulness, such as the capacity to remain focused on the existing task and the ability to observe many stimuli, such as bodily sensations. Only the capacity to observe many stimuli, such as thoughts, feelings, and bodily sensations, was positively associated with various measures of creativity, including past creative achievements and original solutions to problems.

Arguably, when people can observe, notice, and attend to many thoughts, feelings, and sensations, their thinking becomes more flexible. They can more readily shift the focus of their attention and thus can contemplate a more diverse range of possibilities, enhancing creativity. They may be able to uncover subtle cues that many people overlook. Thus training individuals to be aware of their thoughts, feelings, and sensations could foster creativity. In contrast, attention to the existing task may not offer these benefits and, in some instances, stifle these benefits.

Antecedents of mindfulness

Several factors can interfere with this awareness and attention, ultimately curbing mindfulness, as delineated by Brown and Ryan (2003). First, rumination over the past or fantasies over the future can distract attention from ongoing events. Second, the distribution of attention to several concurrent tasks can also impede mindfulness. Third, habitual and automatic behavior, without any awareness or attention, reduces mindfulness. Finally, denial or suppression, often intended to circumvent undesirable emotions, also impairs mindfulness.

Mechanisms that underpin the benefits of mindfulness

Self determination and autonomy

Self determination theory, propounded by Deci and Ryan (1980, 1985), is sometimes invoked to explain the benefits of mindfulness (Brown & Ryan, 2003). In particular, mindfulness might correspond to an awareness of personal needs, values, and interests. As a consequence, individuals are able to choose courses of action that align with their core values, which ultimately promotes wellbeing (Ryan & Deci, 2000).

Consistent with this premise, Brown and Ryan (2003) showed that individuals who report elevated scores of mindfulness also feel their desire for autonomy, competence, and connections with other people are fulfilled. When individuals experience a state of mindfulness, they are also more inclined to engage in activities because they align to their value or interest, not because of demands from anyone else. Furthermore, when mindfulness is elevated, explicit and implicit measures of affect are more likely to concur. This observation also indicates that mindfulness might facilitate an awareness of unconscious needs and inclinations.

Modest desires

Mindfulness might also curb unrealistic or lofty goals and desires, which can enhance wellbeing. In a study conducted by Brown, Kasser, Ryan, Linley, and Orzech (2009), for example, participants answered a series of questions that gauge their level of mindfulness as well as their current and desired financial status diverge, with questions such as "How well does your current financial status right now approach what you want". Furthermore, their emotional state and satisfaction with life was assessed to gauge subjective wellbeing.

Mindfulness was inversely related to the discrepancy between current and desired financial status. Interestingly, this relationship was observed even after annual income, household income, savings, debt, and assets were controlled. In other words, mindfulness seems to improve satisfaction with financial status, regardless of actual wealth. Accordingly, when individuals experience a mindful orientation, their desired level of wealth seems to dissipate, which in turn evokes happiness and satisfaction (Brown, Kasser, Ryan, Linley, & Orzech, 2009). Furthermore, the same pattern of results emerged when training was convened to manipulate levels of mindfulness (Brown, Kasser, Ryan, Linley, & Orzech, 2009).

Several mechanisms might underpin the observation that mindfulness curbs lofty financial goals (see Burch, 2000& Rosenburg, 2004). First, when individuals adopt a mindful orientation, they tend to appreciate their immediate subjective experiences in lieu of material goods. The importance of wealth and status tends to wane (Brown & Kasser, 2005).

Second, because mindful individuals are more attuned to their intrinsic desires, they might be less susceptible to advertising. In contrast, the desired wealth of other individuals might soar as a consequence of advertising campaigns and other social forces (Brown, Kasser, Ryan, Linley, & Orzech, 2009).

Finally, when individuals demonstrate a mindful state, they are more likely to accept their circumstances and state (e.g., Baer, 2003). This acceptance might extend to their financial status as well.

Relaxation

Conceivably, as several authors acknowledge (e.g., Dunn, Hartigan, & Mikulas, 1999), the benefits of mindfulness could merely be ascribed to affective states, such as relaxation. Certainly, mindfulness does reduce anxiety or arousal (Kabat-Zinn, 1990), and such emotional states or moods can enhance resilience and promote other benefits (e.g., Kuhl, 2000& see Personality systems interaction theory).

Despite the affective consequences of mindfulness meditation, such practices are not intended to improve emotional states immediately. Indeed, mindfulness should enable individuals to experience and recognize negative affect rather than suppress or evade these emotions (e.g., Kabat-Zinn, 2003).

Specific attributions

Mindfulness might also curb the inclination of individuals to form global negative evaluations about themselves. To illustrate, some individuals extract broad negative attributions about themselves from specific events. They might perceive themselves as hopeless in general after failures in specific contexts only--an attribution style that is associated with depression. This inclination to form global evaluations also coincides with memories of general, rather than specific, autobiographical events. Mindfulness, in which individuals orient their attention to the specific context, rather than connect event to past or future episode, has been shown to ameliorate this inclination and thus, at least sometimes, could prevent depression (Williams, Teasdale, Segal, & Soulsby, 2000).

Cognitive defusion

Mindfulness meditation might increase the capacity of individuals to detach themselves from their thoughts. Some individuals conceptualize their thoughts, such as the words "I am too fat", as a veridical reflection of reality. As a consequence, the responses that such reality might evoke--such as urges to shun social situations as well as feelings of shame--are also elicited by the thought (Masuda, Hayes, Sackett, & Twohig, 2004& see ACT therapy).

After mindfulness training, however, individuals might assume that thoughts are not necessarily representations of reality. These thoughts, instead, are conceptualized as transient, ephemeral events--a process called cognitive defusion (Hayes, 2003& Hayes, Strosahl, & Wilson, 1999).

After this realization, the thoughts are less likely to evoke the sequence of responses that an authentic event might elicit. Instead, individuals can respond more flexibly rather than rigidly. Furthermore, individuals do not feel the urge to inhibit, evade, or modify these thoughts. These thoughts are not tangible problems that need to be defeated (cf., Baer, 2003). Even repeating an upsetting thought, deliberately and audibly, for over half a minute can foster these benefits (Masuda, Hayes, Sackett, & Twohig, 2004).

Indeed, many of the accounts and narratives that relate to mindfulness allude to this detachment from thoughts. Brown, Ryan, and Creswell (2007), for example, maintain that mindfulness instills a dislocation between the objects of which individuals are aware and the responses that such stimuli would usually evoke. Likewise, Kabat-Zinn (1990) introduced the concept of choiceless awareness, in which individuals become aware of some experience or object, without the need to engage, evaluate, or elucidate this stimulus.

Diminution of defensive reactions

When individuals experience some problem or difficulty, a host of defensive reactions often ensue. They might, for example, attempt to suppress their emotions or evade some setting in the future. Similarly, they might divorce themselves from social interactions, because of a sense of distrust, roughly corresponding to an insecure attachment (see attachment theory).

Some evidence indicates that mindfulness might preclude some of these maladaptive defensive reactions. Mindfulness, for example, is associated with acceptance of negative emotions or thoughts (Brown & Ryan, 2004& Hayes, 1994& Roemer & Orsillo, 2002). As a consequence, the inclination to suppress emotions--an inclination that often aggravates these feelings (Wegner, 1994)--diminishes (see Ironic rebound). Furthermore, mindfulness may be related to a secure rather than insecure attachment style (Shaver, Lavy, Saron, & Mikulincer, 2007).

Neurological underpinnings

Many studies have explored the neurological correlates of mindfulness meditation (e.g., Davidson, Kabat-Zinn, Schumacher, Rosenkranz, Muller, Santorelli et al., 2003). Mindfulness meditation does indeed correspond to a specific profile of brain activation--a profile that persists after the meditation session is completed (Lutz, Greischar, Rawlings, Ricard, & Davidson, 2004). Indeed, voxel-based morphometry, which is used to examine the volume of brain structures, has shown volumetric change after mindfulness meditation is practiced (Holzel, Ott, Gard, Hempel, Weygandt, Morgen, et al., 2007). The level of change tends to correlate with the hours of practice (Lazar, 2005).

Mindfulness might also be associated with right lateralized activation of the prefrontal cortex, including the ventromedial prefrontal cortex, the dorsolateral prefrontal cortex, and the insula (Farb, Segal, Mayberg, Bean, McKeon, Fatima, et al., 2007). Specifically, these regions are associated with an orientation, called experiential focus, in which individuals focus their attention on momentary experiences rather than strive to integrate ongoing events with more enduring representations of themselves. In contrast, other midline regions, such as the medial prefrontal cortex, seem to mediate a narrative focus, in which individuals relate immediate events to more enduring traits about themselves, sometimes provoking rumination. This region also relates to memory of traits, knowledge about the self, and aspirations of the future--somewhat akin to a promotion focus (see Regulatory focus theory).

Attention regulation

During mindfulness meditation, individuals often attempt to focus their attention on one object, image, or concept, such as a candle. Whenever their focus ventures to other distractions, they attempt to redirect their attention to this object, image, or concept, called attention regulation. Holzel, Lazar, Gard, Shuman-Olivier, Vago, and Ott (2011) reviewed the neuropsychological improvements, neurological processes, and structural changes that correspond to attention regulation.

In particular, mindfulness has been shown to enhance the ability of people to control attention, as gauged by decreases in Stroop interference, for example. Furthermore, mindfulness meditation seems to increase activation of the rostral anterior cingulate cortex and is associated with thickness of the dorsal anterior cingulate cortex. This region, together with the front-insular cortex, is vital to the capacity of individuals to switch attention between distinct brain networks. Thus, mindfulness meditation could assist disorders that correspond to deficits in the anterior cingulate cortex and the limited control of attention, such as bipolar disorder.

Body awareness

Mindfulness meditation also facilitates body awareness, in which individuals become more aware of sensory experiences and bodily sensations, such as their breathing. Consistent with these possibilities, and as outlined by Holzel, Lazar, Gard, Shuman-Olivier, Vago, and Ott (2011), mindfulness meditation has been shown to increase activation of the insular cortex--vital to awareness of bodily sensations--as well as the size of the right anterior insula. In addition, mindfulness meditation tends to increase activation of the secondary somatosensory area, pertinent to the awareness of external stimuli. Finally, mindfulness meditation increases the concentration of gray matter in the temporo-parietal junction. This region enables individuals to connect specific bodily sensations to the self, diminishing the likelihood of out-of-body experiences for example.

These changes in body awareness have been shown to generate many benefits, including empathy. Improvements in body awareness, for example, diminish the likelihood of eating disorders, substance abuse, and perhaps borderline personality disorder.

Responses to emotional events

According to Farb, Anderson, Mayberg, Bean, McKeon, and Segal (2010), when individuals feel sad, regions of the brain that highlight the personal consequences of various problems are activated. Consequently, individuals become more aware of how these problems could affect their life, evoking rumination. In contrast, after individuals undergo mindfulness training, different regions of the brain are more likely to be activated. These regions primarily represent the bodily sensations that correspond to emotions, such as tension of the stomach. Accordingly, after mindfulness training, individuals are not as likely to ruminate over the implications of various complications, containing unnecessary worry in the future and confining their attention to only their immediate experiences.

Farb, Anderson, Mayberg, Bean, McKeon, and Segal (2010) reported a study that illustrates these premises. In this study, some but not all participants received mindfulness training. That is, they learnt to direct their attention to the visceral and bodily experiences while undertaking everyday tasks. They also learnt to accept and observe, rather than evaluate or appraise, these experiences. They conceptualized these experiences and feelings as fleeting moments rather than consequential states.

Next, all participants watched either sad or neutral film clips. A minute or so after reflecting on each clip, participants rated the extent to which they feel sad on a five point scale. Subsequently, they completed measures of anxiety, depression, and stress during a separate session.

The extent to which participants rated the movie as sad did not depend on whether or not they had completed mindfulness training. Thus, mindfulness training did not curb or amplify feelings of dejection. Nevertheless, after training, levels of anxiety and depression were lower in the individuals who had received this training.

Compared to the neutral clips, the sad clips was more likely to activate a raft of regions. However, whether or not participants received mindfulness training affected which regions were activated. Sadness activated some regions more intensely in the control participants. Specifically, in the participants who did not receive mindfulness training, sadness was especially likely to activate the right precuneus and posterior cingulate (Brodmann areas 7 and 31 respectively) as well as the superior temporal sulcus coupled with Wernicke's area (Brodmann areas 42 and 22 respectively), the inferior temporal gyrus, and Broca's area (Brodmann area 47).

The right precuneus and posterior cingulate are activated when individuals reflect on their traits. The other areas are activated, especially Wernicke's area and Broca's area, when individuals process or express language. These language regions tend to be inversely correlated with activation in the insular cortex, which represents somatosensory states (see Farb, Anderson, Mayberg, Bean, McKeon, & Segal, 2010). Taken together, these findings indicate that mindfulness training reduces the likelihood that individuals reflect upon how events may compromise their self concept. Furthermore, mindfulness training confines attention to somatosensory states.

Indeed, sadness activated some regions more intensely in the participants who had received mindfulness training. If participants had not received mindfulness training, the sad movie, relative to the neutral movie, tended to inhibit activation of the right basal ganglia extending to the right insular cortex, the right subgenal anterior cingulate cortex and gyrus rectus (Brodmann areas 25 and 11 respectively, towards the bottom of the frontal lobes), the right superior frontal gyrus (Brodmann area 9--and sometimes regarded as part of the dorsolateral prefrontal cortex), and the right ventrolateral prefrontal cortex (Brodmann area 45).

The insular cortex and anterior cingulate cortex enable individuals with mindfulness training to recognize these negative states without necessarily contemplating their consequences, curbing rumination. Nevertheless, activation of the superior frontal gyrus and ventrolateral prefrontal cortex enables individuals to focus on potential solutions, without worrying about possible consequences. Hence, mindfulness enables individuals to connect emotional states with possible goals and solutions rather than worries and concerns.

Reappraisal and exposure to negative emotions

Holzel, Lazar, Gard, Shuman-Olivier, Vago, and Ott (2011) reviewed the effect of mindfulness meditation on the regulation of emotions. Overall, mindfulness meditation does facilitate emotional regulation. In general, the capacity of individuals to regulate emotions reflects increased activation of various regions in the prefrontal cortex, coupled with reduced activation of the amygdala.

In particular, mindfulness meditation enables individuals to reappraise negative events more favorably. That is, when mindful, individuals can reflect upon negative events, without judging themselves harshly. They can, therefore, contemplate the positive consequences of adverse events. Reappraisal is assumed to correspond more with dorsal or medial, rather than frontal or ventral, regions of the prefrontal cortex. Consistent with this possibility, when individuals are asked to reappraise negative events, these dorsal-medial regions are especially likely to be activated if trait mindfulness is elevated (Modinos Ormel & Aleman 2010).

Although some studies show that mindfulness meditation enhances prefrontal activity, other studies show that mindfulness meditation diminishes prefrontal activity (for a review, see Holzel, Lazar, Gard, Shuman-Olivier, Vago, & Ott, 2011). Presumably, in some circumstances, mindfulness enables individuals to experience, rather than reappraise or regulate, negative events. That is, mindfulness increases the likelihood that individuals are willing to expose themselves to these unpleasant experiences. Over time, the intensity of negative emotions thus diminishes, as individuals learn to associate these unpleasant events with inconsequential, rather than aversive, outcomes.

The ventromedial prefrontal regions, including the orbitofrontal prefrontal cortex, facilitates this extinction of intense emotions. That is, this region enables individuals to learn that specific adversities do not translate to negative consequences (see somatic marker hypothesis). Furthermore, the hippocampus also seems to facilitate these changes. Indeed, mindfulness meditation has been shown to increase the concentration of gray matter in the ventromedial prefrontal regions and augment activation of the hippocampus.

Changes in the perspective of the self

When individuals practice mindfulness meditation, they eventually begin to perceive themselves from the perspective of someone else. That is, they virtually observe themselves (e.g., Kerr, Josyula & Littenberg 2011). Consequently, they can conceptualize themselves as a dynamic process and not a static entity.

Indeed, mindfulness meditation, as reviewed by Holzel, Lazar, Gard, Shuman-Olivier, Vago, and Ott (2011), has been shown to diminish activation of the brain regions that correspond to relating information to the self, called self-referential processing. These regions include the medial areas of the prefrontal cortex, which underpins memory and knowledge of personal traits, as well as the precuneus and posterior cingulate cortex, which determines whether an event is relevant to the self.

Practical implications

Mindfulness training

Many practitioners now engage in training that is intended to facilitate mindfulness--a program that spans several weeks or months. Speca, Carlson, Goodey, and Angen (2000), for example, describe this training program in some detail. First, participants receive theoretical information, such as the recognition that relaxing the body can facilitate a calm mental state. Second, they practice techniques that are intended to promote mindfulness. Finally, they discuss their experiences with these techniques in a group setting, partly intended to uncover measures to redress impediments to effective practice.

In particular, the program comprises several phases. First, individuals engage in relaxation exercises, involving deep breathing and awareness of various bodily sensations. Second, individuals engage in visualization exercises, imagining particular tastes, demonstrating the relationships between mental and physical responses. In addition, individuals are asked to direct their attention to each part of the body in sequence, focusing on the sensations they experience, and encouraged to complete this exercise at home. Third, information about the physiological correlates of stress and the use of breathing as an anchor for attention are presented. Fourth, using these breathing exercises in everyday contexts, such as walking, is discussed.

After individuals practice these exercises, they receive information about cognitive distortions and irrational assumptions. Individuals learn to monitor these cognitive appraisals and challenge these distorted beliefs. Visualizing peaceful images to amplify mindfulness is introduced.

Individual solutions

Rather than participate in official training, individuals can engage in some exercises to foster mindfulness, attempting to circumvent the tendencies that obstruct this mental state. First, every hour or so, individuals could sit quietly for a few minutes, focusing their attention on their breath. They could, then, reflect upon their surroundings or their mental state-their emotions, thoughts, and so forth.

Second, individuals should attempt to undertake one task at a time, not shifting erratically across activities. They could, for example, decide to maintain focus on one task for at least 15 minutes before then contemplating the next activity.

Third, every week, individuals should attempt to identify one thought or feeling they might be suppressing or neglecting-perhaps a concern over their behavior towards a friend, perhaps their worry they might not be able to fulfill some deadline. They could reflect upon this thought or feeling, for a moment, without attempting to generate solutions. They should merely be aware of this cognition or emotion.

Measures

Brown and Ryan (2003) developed and validated the Mindful Attention Awareness Scale, or MAAS, to measure individual differences in mindfulness. Participants answer 15 items, such as "I find myself doing things without paying attention", "I find it difficult to stay focused on what is happening in the present", "I could be experiencing some emotion and not be conscious of it until some time later", and "I rush through activities without being really aware of them" on a six point rating scale. Because individuals are probably more cognizant of mindlessness than mindfulness, all of the items portray neglect, distraction, or oblivion rather than awareness or attention and are reverse coded.

Brown and Ryan (2003) uncovered encouraging psychometric properties. Confirmatory factor analysis revealed that items all corresponded to a single dimension, with Cronbach's exceeding .8. Retests after four weeks uncovered an intraclass correlation of .81 and no significant differences across time. The scale is not significantly correlated with the MMPI lie scale but moderately correlated with the Marlowe-Crowne measure of social desirability. Furthermore, consistent with hypotheses, mindfulness was shown to be elevated in members of a Zen community center compared to individuals in the general population, establishing known group validity.

Baer, Smith, Hopkins, Krietemeyer, and Toney (2006) also developed a measure, called the Five Factor Mindfulness Questionnaire (for psychometric properties, also see Baer, Smith, Lykins, Button, Krietemeyer, Sauer, et al., 2008). The five subscales represent the extent to which individuals observe their feelings and states, describe their immediate environment, maintain awareness of their acts and behaviors, refrain from judging their private states, and abstain from reacting unnecessarily to their inner experiences. The scale comprises 39 items. The average correlation between any two facets is .18, indicating the five facets or skills are distinct.

Overlapping but distinct concepts

Mindfulness does overlap with a variety of concepts, as highlighted by Brown and Ryan (2003). Clarity about emotions, a facet of emotional intelligence (Salovey, Mayer, Goldman, Turvey, & Palfai, 1995), is likely to be associated with mindfulness. Likewise, some facets of openness--particularly openness to ideas and feelings--should be related to mindfulness as well.

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