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How Does Mindfulness Reduce Anxiety, Depression, and Stress? An Exploratory Examination of Change Processes in Wait-List Controlled Mindfulness Meditation Training

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Abstract

The evidence base supporting mindfulness meditation training (MMT) as a potential intervention for anxiety, depression, and stress has grown dramatically in the last few decades. As MMT has grown in popularity, considerable variation has arisen in the way that mindfulness is conceptualized and in the trainings and interventions that have been included under this umbrella term. Increasing popularity has also raised concerns about how MMTs seem to have their effects. While previous studies have examined a wide variety of potential mechanisms, few studies have simultaneously examined these processes, potentially limiting conclusions about how MMTs might best be characterized as having their effects. The present study aimed to compare aspects of mindfulness, self-compassion, and emotion regulation, ascertaining which was most predictive of changes in anxiety, depression, and stress among 58 participants, randomly assigned on a 2:1 basis to MMT training or wait-list in a pre-/post-assessment design. The results indicated that the facets of overidentification and self-judgment (components of self-compassion) were most robustly predictive of changes in outcome variables, though mindfulness and emotion regulation also contributed. The findings suggest that mindfulness, as a process, may be more complicated than some have given credit and that attention and emotional balance may be particularly important aspects related to its effects.

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Notes

  1. Centre for Clinical Interventions. (2007). What is mindfulness? Retrieved January 1st, 2009 from http://www.cci.health.wa.gov.au/docs/ACF3C5B.pdf

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Acknowledgements

This project was supported by grant MLI-FJVRF-08-001, awarded to N.T.V.D. by Mind and Life Institute and by contributions from the Department of Psychology at the University at Albany, SUNY. The authors wish to thank Karen Beetle, M.A., LMHC, Lenore Flynn, RN, M.A., and Steve Flynn, M.A., for skillfully conducting the meditation training. We are also grateful to Sean Aucoin, Lynsey Avalone, Brynn Benishake, Patrick Clark, Christine Coyne, Justina Farley, Stacey Farmer, Alix Markoff, Robbie Orapello, Jenny Rella, Michelle Stiles, Ian Taras, and Laura Wynkoop for their invaluable technical assistance.

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Authors and Affiliations

  1. Department of Psychology, University at Albany, SUNY, 1400 Washington Ave, Albany, NY, 12222, USA

    Nicholas T. Van Dam, Andréa L. Hobkirk, Rebecca Aviles-Andrews & Mitch Earleywine

  2. National Center for Veterans Studies, University of Utah, Salt Lake City, UT, USA

    Sean C. Sheppard

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  1. Nicholas T. Van Dam
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  2. Andréa L. Hobkirk
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  5. Mitch Earleywine
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Correspondence to Nicholas T. Van Dam.

Appendix

Appendix

A1. Overview of Intervention Protocol

Session 1: New Beginnings

  1. I.

    Names and what individuals noticed on their way to campus.

    1. a.

      Cocktail Party by T.S. Eliot

  2. II.

    Setting course expectations

    1. a.

      Island of Being

    2. b.

      What brings you here?

    3. c.

      What is mindfulness?

  3. III.

    Raisin exercise

  4. IV.

    Experience/Qualities of being present

    1. a.

      past/future versus present

  5. V.

    Brief Body Scan (approximately 15-20 min)

  6. VI.

    HANDOUT: Mindfulness OverviewFootnote 1

  7. VII.

    Closing Remarks

Homework: Eat one food mindfully 1x/day; Checking in – where you are 1x/day; Body Scan 1x/day

Session 2: Being in Your Body

  1. I.

    Welcome Back

    1. a.

      Commend the effort required to return

  2. II.

    Review of Mindfulness

    1. a.

      Why the body scan? Section on Body Scan (from MBSR)Footnote 2

    2. b.

      Share experiences/difficulties with Body Scan and Mindful Practice

    3. c.

      HANDOUT: Common Hang-ups (from MBCT)Footnote 3

  3. III.

    Stress 101: Why should you stick with it?

  4. IV.

    Qualities that Support Practice

    1. a.

      HANDOUT: pp 33–40 (MBSR)2

  5. V.

    The Qualities of Practice

    1. a.

      Purpose, goals, experience

  6. VI.

    Introduction to Sitting Practice

    1. a.

      Posture: Sit so as to embody dignity

    2. b.

      The influence of posture/gestures on feelings/mood

    3. c.

      10 minutes of breathing

  7. VII.

    Closing Remarks

Homework: Body Scan 1×/day; 10 min sitting meditation 1×/day

Session 3: Being with your Experience

  1. I.

    Brief Sitting Meditation (10 min)

  2. II.

    Body Scan (20 min)

  3. III.

    Mindfulness of Emotion

    1. a.

      The Guest House by Rumi

    2. b.

      How do you work with emotion?

      1. i.

        Riding the waves of emotion

  4. IV.

    Basics of Depression and AnxietyFootnote 4

    1. a.

      What does depression/anxiety feel like?

    2. b.

      How do you relate to the experience of depression/anxiety?

  5. V.

    Introduction to Mindful Yoga

    1. a.

      The Practice

    2. b.

      Meeting your limitations

    3. c.

      Being present and making choices

    4. d.

      Caring for myself

    5. e.

      HANDOUT: Yoga Postures (MBSR)2

    6. f.

      Brief Practice (time permitting)

Homework: Pleasant experiences questionnaire; Alternate Body Scan/Yoga daily; 20 min Sitting Med daily

Session 4: Being Present

  1. I.

    Sitting Meditation (20 min)

    1. a.

      Focus on Sound

    2. b.

      Focus on Breath

  2. II.

    Discussion of Qualities of different anchors

  3. III.

    The Raft Analogy (annotated from works by Stephen Batchelor)Footnote 5

  4. IV.

    Introduction to Breathing Space

  5. V.

    Discussion of Meditation Experiences

  6. VI.

    Review Mindfulness of Emotions

  7. VII.

    Mountain Meditation (40 min)

Homework: Breathing Space (3× day); Alternate Sitting (20 min)/Mountainn Med (20 min); Yoga 5 days of week

Session 5: Staying Present

  1. I.

    Sitting Meditation (30 min)

  2. II.

    Getting Closer to Our Experience (excerpt from writings of Sharon Salzberg)Footnote 6

  3. III.

    Mindfulness of Thoughts

    1. a.

      Introductory Activities from MBCT3

  4. IV.

    Encountering Obstacles

    1. a.

      Drawing your obstacles

    2. b.

      Discuss drawings

Homework: Breathing Space in difficult moments (min 1x day; record ABCs); Alternate Sitting Meditation (40 min) & Body Practice (Body Scan or Yoga)

Session 6: Being with Uncertainty

  1. I.

    Introduction to Walking Practice

    1. a.

      HANDOUT: Overview of Walking Meditation by Thich Nhat HanhFootnote 7 Walking Practice (20 min)

  2. II.

    Stress & Uncertainty

    1. a.

      Excerpt from Crossing the Unknown Sea by David Whyte (pp 411–412)Footnote 8

    2. b.

      HANDOUT: Change: One thing you can be sure of (MBSR)2

    3. c.

      Life is Change

    4. d.

      How is mindfulness a support?

    5. e.

      Managing the gaps

    6. f.

      What is Solace?

  3. III.

    Allowing Things to Be as They Are

    1. a.

      Intentions for the practice

    2. b.

      What are your intentions now?

Homework: Breathing Space in difficult moments (min 1x day; record ABCs); Alternate Sitting Meditation (40 min) & Body Practice (Body Scan or Yoga)

*DAY OF MINDFULNESS*

Session 7: Caring for Yourself and Your World

  1. I.

    Lovingkindness Practice (30 min)

  2. II.

    Being Gentle with Yourself

    1. a.

      Wild Geese by Mary Oliver

    2. b.

      Desiderata by Max Ehrmann

  3. III.

    Cultivating Gentleness

    1. a.

      Finding your triggers to Negative Talk/Emotions

    2. b.

      How to meet yourself in the moment

    3. c.

      Practice as purification

  4. IV.

    Introduction to Brahmavihara

    1. a.

      Excerpt from Teachings on Love by Thich Nhat HanhFootnote 9

  5. V.

    Introduction to Compassion Practice

Homework: You pick daily (1 ea. lovingkindness, compassion)

Session 8: Life is Practice

  1. I.

    Acknowledging the end

  2. II.

    Sitting Meditation (30 min)

  3. III.

    Awakening to Change

  4. IV.

    Formal vs. Informal Practice

  5. V.

    Resources for Cultivating your Practice

    1. a.

      HANDOUT: local resources

  6. VI.

    Lovingkindness Practice (30 min)

  7. VII.

    Keeping Quiet by Pablo Neruda

  8. VIII.

    Final Sit (30 min)

  9. IX.

    You Reading This, Be Ready by William Stafford

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Van Dam, N.T., Hobkirk, A.L., Sheppard, S.C. et al. How Does Mindfulness Reduce Anxiety, Depression, and Stress? An Exploratory Examination of Change Processes in Wait-List Controlled Mindfulness Meditation Training. Mindfulness 5, 574–588 (2014). https://doi.org/10.1007/s12671-013-0229-3

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