Abstract
Recent research has begun to distinguish between various aspects of self-report measures of mindfulness, including the distinction between mindful process and outcome. Therefore, our primary goal in this study was to examine whether an increase in mindful outcome mediated the relationship between an increase in mindful process and improvements in mental and physical health and perceived stress among mindfulness-based stress reduction (MBSR) participants. Consistent with expectations, we found that changes in mindful outcome partially mediated relationships between changes in mindful process and two outcomes: mental health and perceived stress (but not physical health). Moreover, as expected, in an alternate model, changes in mindful outcome did not facilitate changes in mindful process and improvements in any of the outcome variables. The implications and limitations of these findings, as well as recommendations for future research, are discussed.
Similar content being viewed by others
References
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45. doi:10.1177/1073191105283504.
Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., & Williams, J. M. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342. doi:10.1177/1073191107313003.
Baer, R. A., Carmody, J., & Hunsiger, M. (2012). Weekly changes in mindfulness and perceived stress in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 68(7), 755–765.
Bohlmeijer, E., ten Klooster, P. M., Fledderus, M., Veehof, M., & Baer, R. (2011). Psychometric properties of the Five Facet Mindfulness Questionnaire in depressed adults and development of a short form. Assessment, 18, 308–320. doi:10.1177/1073191111408231.
Bränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients: a randomized study. Annals of Behavioral Medicine, 39, 151–161. doi:10.1007/s12160-010-9168-6.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848. doi:10.1037/0022-3514.84.4.822.
Chiesa, A., & Serretti, A. (2009). Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. Journal of Alternative and Complementary Medicine, 15(5), 593–600. doi:10.1089/acm.2008.0495.
Christopher, M. S., Neuser, N. J., Michael, P. G., & Baitmangalkar, A. (2012). Exploring the psychometric properties of the Five Facet Mindfulness Questionnaire. Mindfulness, 3, 124–131. doi:10.1007/s12671-011-0086-x.
Christopher, M. S., Woodrich, L. E., & Tiernan, K. A. (2013). Using cognitive interviews to assess the cultural validity of state and trait measures of mindfulness among Zen Buddhists. Mindfulness. doi:10.1007/s12671-012-0160-z.
Cohen, S., & Williamson, G. M. (1988). Perceived stress in a probability sample of the United States. In S. Spacapam & S. Oskamp (Eds.), The social psychology of health (pp. 31–67). Newbury Park, CA: Sage.
Creswell, J. D., Irwin, M. R., Burklund, L. J., Lieberman, M. D., Arevalo, J. M. G., Ma, J., & Cole, S. W. (2012). Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain, Behavior, and Immunity, 26(7), 1095–1101. doi:10.1016/j.bbi.2012.07.006.
Daubenmier, J., Kristeller, J., Hecht, F. M., Maninger, N., Kuwate, M., Jhaveri, K., & Epel, E. (2011). Mindfulness intervention for stress eating to reduce cortisol and abdominal fatamong overweight and obese women: an exploratory randomized controlled study. Journal of Obesity. doi:10.1155/2011/651936.
Davis, J. M., Fleming, M. F., Bonus, K. A., & Baker, T. B. (2007). A pilot study on mindfulness based stress reduction for smokers. BMC Complementary and Alternative Medicine, 7(1), 2–15.
de Bruin, E. I., Topper, M., Muskens, J. G. A. M., Bögels, S. M., & Kamphuis, J. H. (2012). Psychometric properties of the Five Facet Mindfulness Questionnaire (FFMQ) in a meditating and a non-meditating sample. Assessment, 19(2), 187–197. doi:10.1177/1073191112446654.
de Vibe, M., Bjørndal, A., Tipton, E., Hammerstrøm, K. T., Kowalski, K. (2012). Mindfulness based stress reduction (MBSR) for improving health, quality of life and social functioning in adults. Campbell Systematic Reviews, 3. doi: 10.4073/csr.2012.3
Eberth, J., & Sedelmier, P. (2012). The effects of mindfulness meditation: a meta-analysis. Mindfulness, 3, 174–189.
Erisman, S. M., & Roemer, L. (2012). A preliminary investigation of the process of mindfulness. Mindfulness, 3, 30–43. doi:10.1007/s12671-011-0078-x.
Exford, T. J. (2012). Mindfulness, exercise and stress reduction: The effects of a university physical education mindfulness-based exercise course in increasing physical activity (Doctoral dissertation,Auburn University). Retrieved from http://hdl.handle.net/10415/3299
Fang, C. Y., Reibel, D. K., Longacre, M. L., Rosenzweig, S., Campbell, D. E., & Douglas, S. D. (2010). Enhanced psychosocial well-being following participation in a mindfulness- based stress reduction program is associated with increased natural killer cell activity. The Journal of Alternative and Complementary Medicine, 16(5), 531–538. doi:10.1089/acm.2009.0018.
Garland, S. N., Tamagawa, R., Todd, S. C., Speca, M., & Carlson, L. E. (2013). Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integrative Cancer Therapies, 12(1), 31–40.
Gaylord, S. A., Passon, O. S., Garland, E. L., Faurot, K. R., Coble, R. S., Mann, J. D., & Whitehead, W. E. (2011). Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial. American Journal of Gastroenterology, 106(9), 1678–1688. doi:10.1038/ajg.2011.184.
Greeson, J. M., Webber, D. M., Smoski, M. J., Brantley, J. G., Ekblad, A. G., Suarez, E. C., & Wolever, R. Q. (2011). Changes in spirituality partly explain health-related quality of life outcomes after mindfulness-based stress reduction. Journal of Behavioral Medicine, 34, 508–518. doi:10.1007/s10865-011-9332-x.
Gross, C. R., Kreitzer, M. J., Reilly-Spong, M., Wall, M., Winbush, N. Y., Patterson, R., & Cramer-Bornemann, M. (2011). Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. Explore: The Journal of Science and Healing, 7(2), 76–87. doi:10.1016/j.explore.2010.12.003.
Grossman, P., & Van Dam, N. T. (2011). Mindfulness by any other name…: trials and tribulations of sati in Western psychology and science. Contemporary Buddhism, 12, 219–239. doi:10.1080/14639947.2011.564841.
Hays, R. D., Bjorner, J. B., Revicki, D. A., Spritzer, K. L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873–880.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183. doi:10.1037/a0018555.
Isenberg, L. (2009). Mindfulness—Life with attention and awareness: test-retest reliability of the FFMQ for Dutch fibromyalgia patients. (Unpublished master’s thesis). University of Twente, Netherlands.
Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York: Dell Publishing.
Keng, S.-L., Smoski, M. J., Robins, C. J., Ekblad, A. G., & Brantley, J. G. (2012). Mechanisms of change in mindfulness-based stress reduction: self-compassion and mindfulness as mediators of intervention outcomes. Journal of Cognitive Psychotherapy, 26(3), 270–280. doi:10.1891/0889-8391.26.3.270.
Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112. doi:10.1016/j.brat.2010.08.003.
Ledesma, D., & Kumano, H. (2009). Mindfulness-based stress reduction and cancer: a meta- analysis. Psychooncology, 8(6), 571–579. doi:10.1002/pon.1400.
Lykins, E. L. B., & Baer, R. A. (2009). Psychological functioning in a sample of long-term practitioners of mindfulness meditation. Journal of Cognitive Psychotherapy, 23, 226–241. doi:10.1891/0889-8391.23.3.226.
Nyklícek, I., & Kuijpers, K. F. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35(3), 331–340. doi:10.1007/s12160-008-9030-2.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Rogers, B. S., Christopher, M. S., & Bilgen-Sunbay, Z. (2013). Mindfulness, self-care, and participatory medicine: a community’s clinical evidence. Journal of Participatory Medicine, 5, e9.
Schmidt, S., Grossman, P., Schwarzer, B., Jena, S., Naumann, J., & Walach, H. (2011). Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain, 152(2), 361–369.
Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: results from a randomized trial. International Journal of Stress Management, 12(2), 164–176.
Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating mindfulness: effects on well-being. Journal of Clinical Psychology, 64, 840–862.
Vøllestad, J., Sivertsen, B., & Nielsen, G. H. (2011). Mindfulness-based stress reduction for patients with anxiety disorders: Evaluation in a randomized controlled trial. Behaviour Research and Therapy, 49(4), 281–288. doi:10.1016/j.brat.2011.01.007.
Witek-Janusek, L., Albuquerque, K., Chroniak, K. R., Chroniak, C., Durazo-Arvizu, R., & Mathews, H. L. (2008). Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity, 22(6), 969–981. doi:10.1016/j.bbi.2008.01.012.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Christopher, M.S., Rogers, B., Hunsinger, M. et al. Distinguishing Mindful Process from Outcome in the Prediction of Global Health and Perceived Stress in a Mindfulness-Based Stress Reduction Program. Mindfulness 6, 693–699 (2015). https://doi.org/10.1007/s12671-014-0305-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12671-014-0305-3