Abstract
The current study investigated purported mechanisms by which mindfulness-based programs (MBP) improve depression symptoms, specifically, whether mindfulness-related changes in the processing of self-referential and/or emotionally valenced information are associated with improvements in depression symptoms. Four domains of the Self-Reference Task (SRT)—valence bias, self-bias, negative self-bias and positive self-bias in memory recall—were assessed before and after an 8-week MBP in 95 individuals with mild-severe depression symptoms. Associations between pre-post intervention changes in SRT biases and improvements in mindfulness skill acquisition and depression symptoms were examined. Intervention-related changes in SRT biases were also examined as a function of treatment response. Mindfulness skill acquisition from baseline to week eight was significantly associated with decreased self-bias and decreased negative self-bias. Improvement in depression symptom severity from baseline to week 20 was significantly associated with pre-to-post intervention decreases in negative valence bias and increases in positive self bias, but not changes in self-bias or negative self bias. Changes in valence bias significantly interacted with treatment response, while self biases did not. These findings suggest that MBPs decrease depression symptoms through changes in valence and valenced self rather than a global reduction in self-referential processing.
Trial registration clinicaltrials.gov NCT01831362
This is a preview of subscription content, access via your institution.

References
Alsubaie, M., Abbott, R., Dunn, B., Dickens, C., Keil, T. F., Henley, W., & Kuyken, W. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74–91. https://doi.org/10.1016/j.cpr.2017.04.008
Anderson, N. H. (1968). Likableness ratings of 555 personality-trait words. Journal of Personality and Social Psychology, 9(3), 272–279. https://doi.org/10.1037/h0025907
Armstrong, L., & Rimes, K. A. (2016). Mindfulness-based cognitive therapy for neuroticism (Stress Vulnerability): A pilot randomized study. Behavior Therapy, 47(3), 287–298. https://doi.org/10.1016/j.beth.2015.12.005
Auerbach, R. P., Bondy, E., Stanton, C. H., Webb, C. A., Shankman, S. A., & Pizzagalli, D. A. (2016). Self-referential processing in adolescents: Stability of behavioral and ERP markers. Psychophysiology, 53(9), 1398–1406. https://doi.org/10.1111/psyp.12686
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(1), 27–45. https://doi.org/10.1177/1073191105283504
Baer, R., Gu, J., Cavanagh, K., & Strauss, C. (2019). Differential sensitivity of mindfulness questionnaires to change with treatment: A systematic review and meta-analysis. Psychological Assessment, 31(10), 1247–1263. https://doi.org/10.1037/pas0000744
Banos, R. M., Medina, P. M., & Pascual, J. (2001). Explicit and implicit memory biases in depression and panic disorder. Behav Res Ther, 39(1), 61–74. https://www.ncbi.nlm.nih.gov/pubmed/11125724
Batink, T., Peeters, F., Geschwind, N., van Os, J., & Wichers, M. (2013). How does MBCT for depression work? studying cognitive and affective mediation pathways. PLoS ONE, 8(8), e72778. https://doi.org/10.1371/journal.pone.0072778
Beck, A. T. (2008). The evolution of the cognitive model of depression and its neurobiological correlates. American Journal of Psychiatry, 165(8), 969–977. https://doi.org/10.1176/appi.ajp.2008.08050721
Bernstein, A., Hadash, Y., Lichtash, Y., Tanay, G., Shepherd, K., & Fresco, D. M. (2015). Decentering and related constructs: a critical review and metacognitive processes model. Perspectives on Psychological Science, 10(5), 599–617. https://doi.org/10.1177/1745691615594577
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology-Science and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy/bph077
Brewer, J. A., Worhunsky, P. D., Gray, J. R., Tang, Y. Y., Weber, J., & Kober, H. (2011). Meditation experience is associated with differences in default mode network activity and connectivity. Proceedings of the National Academy of Sciences, 108(50), 20254–20259. https://doi.org/10.1073/pnas.1112029108
Britton, W. B., Davis, J. H., Loucks, E. B., Peterson, B., Cullen, B. H., Reuter, L., Rando, A., Rahrig, H., Lipsky, J., & Lindahl, J. R. (2018). Dismantling mindfulness-based cognitive therapy: creation and validation of 8-week focused attention and open monitoring interventions within a 3-armed randomized controlled trial. Behaviour Research and Therapy, 101, 92–107. https://doi.org/10.1016/j.brat.2017.09.010
Britton, W. B., Desbordes, G., Acabchuk, R., Peters, S., Lindahl, J. R., Canby, N. K., Vago, D. R., Dumais, T., Lipsky, J., Kimmel, H., Sager, L., Rahrig, H., Cheaito, A., Acero, P., Scharf, J., Lazar, S. W., Schuman-Olivier, Z., Ferrer, R., & Moitra, E. (2021). From self-esteem to selflessness: An evidence (Gap) map of self-related processes as mechanisms of mindfulness-based interventions. Frontiers in Psychology: Psychology in Clinical Settings, 12, 730972. https://doi.org/10.3389/FPSYG.2021.730972
Brockmeyer, T., Zimmermann, J., Kulessa, D., Hautzinger, M., Bents, H., Friederich, H. C., Herzog, W., & Backenstrass, M. (2015). Me, myself, and I: Self-referent word use as an indicator of self-focused attention in relation to depression and anxiety. Frontiers in Psychology, 6, 1564. https://doi.org/10.3389/fpsyg.2015.01564
Brown, K., & Leary, M. (Eds.). (2016) The Oxford Handbook of Hypo-egoic Phenomena. Oxford University Press.
Buddhadasa. (1989) Me and mine. In D. Swearer (Ed.), Selected essays of Bhikkhu Buddhadasa. SUNY press.
Burrows, C. A., Usher, L. V., Mundy, P. C., & Henderson, H. A. (2017). The salience of the self: Self-referential processing and internalizing problems in children and adolescents with autism spectrum disorder. Autism Research, 10(5), 949–960. https://doi.org/10.1002/aur.1727
Chentsova-Dutton, Y. E., & Tsai, J. L. (2010). Self-focused attention and emotional reactivity: The role of culture. Journal of Personality and Social Psychology, 98(3), 507–519. https://doi.org/10.1037/a0018534
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol, 100(3), 316–336. https://www.ncbi.nlm.nih.gov/pubmed/1918611
Cohen, B. (2013) Explaining psychological statistics (Fourth Edition. ed.) [text]. John Wiley & Sons
Cooney, R. E., Joormann, J., Eugene, F., Dennis, E. L., & Gotlib, I. H. (2010). Neural correlates of rumination in depression. Cognitive, Affective, & Behavioral Neuroscience, 10(4), 470–478. https://doi.org/10.3758/CABN.10.4.470
Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., Williams, J. M., & Kuyken, W. (2017). What defines mindfulness-based programs? The warp and the weft. Psychological Medicine, 47(6), 990–999. https://doi.org/10.1017/S0033291716003317
Cuijpers, P., & Smit, F. (2004) Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatr Scand, 109(5), 325–331. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15049768
Cuijpers, P., de Graaf, R., & van Dorsselaer, S. (2004) Minor depression: risk profiles, functional disability health care use and risk of developing major depression. J Affect Disord, 79(1): 71–79. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15023482
Cunningham, S. J., & Turk, D. J. (2017). Editorial: A review of self-processing biases in cognition. Quarterly Journal of Experimental Psychology, 70(6), 987–995. https://doi.org/10.1080/17470218.2016.1276609
Dahl, C. J., Lutz, A., & Davidson, R. J. (2015). Reconstructing and deconstructing the self: Cognitive mechanisms in meditation practice. Trends in Cognitive Sciences, 19(9), 515–523. https://doi.org/10.1016/j.tics.2015.07.001
Dainer-Best, J., Lee, H. Y., Shumake, J. D., Yeager, D. S., & Beevers, C. G. (2018). Determining optimal parameters of the self-referent encoding task: A large-scale examination of self-referent cognition and depression. Psychological Assessment, 30(11), 1527–1540. https://doi.org/10.1037/pas0000602
D’Argembeau, A., Comblain, C., & Van der Linden, M. (2005). Affective valence and the self-reference effect: Influence of retrieval conditions. British Journal of Psychology, 96(Pt 4), 457–466. https://doi.org/10.1348/000712605X53218
De Raedt, R., & Koster, E. H. (2010). Understanding vulnerability for depression from a cognitive neuroscience perspective: A reappraisal of attentional factors and a new conceptual framework. Cognitive, Affective, & Behavioral Neuroscience, 10(1), 50–70. https://doi.org/10.3758/CABN.10.1.50
Deikman, A. J. (1983) The Observing Self: Mysticism and Psychotherapy Beacon Press
Desbordes, G., Gard, T., Hoge, E. A., Holzel, B. K., Kerr, C., Lazar, S. W., Olendzki, A., & Vago, D. R. (2014). Moving beyond Mindfulness: Defining equanimity as an outcome measure in meditation and contemplative research. Mindfulness (n y). https://doi.org/10.1007/s12671-013-0269-8
Di Simplicio, M., Norbury, R., & Harmer, C. J. (2012). Short-term antidepressant administration reduces negative self-referential processing in the medial prefrontal cortex in subjects at risk for depression. Molecular Psychiatry, 17(5), 503–510. https://doi.org/10.1038/mp.2011.16
Dimidjian, S., & Segal, Z. V. (2015). Prospects for a clinical science of mindfulness-based intervention. American Psychologist, 70(7), 593–620. https://doi.org/10.1037/a0039589
Disner, S. G., Shumake, J. D., & Beevers, C. G. (2017). Self-referential schemas and attentional bias predict severity and naturalistic course of depression symptoms. Cognition and Emotion, 31(4), 632–644. https://doi.org/10.1080/02699931.2016.1146123
Dor-Ziderman, Y., Berkovich-Ohana, A., Glicksohn, J., & Goldstein, A. (2013). Mindfulness-induced selflessness: A MEG neurophenomenological study. Frontiers in Human Neuroscience, 7, 582. https://doi.org/10.3389/fnhum.2013.00582
Dunn, B. D., Stefanovitch, I., Buchan, K., Lawrence, A. D., & Dalgleish, T. (2009). A reduction in positive self-judgment bias is uniquely related to the anhedonic symptoms of depression. Behaviour, Research and Therapy, 47(5), 374–381. https://doi.org/10.1016/j.brat.2009.01.016
Durbin, K. A., Mitchell, K. J., & Johnson, M. K. (2017). Source memory that encoding was self-referential: The influence of stimulus characteristics. Memory, 25(9), 1191–1200. https://doi.org/10.1080/09658211.2017.1282517
Eisendrath, S. J., Gillung, E., Delucchi, K. L., Segal, Z. V., Nelson, J. C., McInnes, L. A., Mathalon, D. H., & Feldman, M. D. (2016). A randomized controlled trial of mindfulness-based cognitive therapy for treatment-resistant depression. Psychotherapy and Psychosomatics, 85(2), 99–110. https://doi.org/10.1159/000442260
Everaert, J., Duyck, W., & Koster, E. H. (2014). Attention, interpretation, and memory biases in subclinical depression: A proof-of-principle test of the combined cognitive biases hypothesis. Emotion, 14(2), 331–340. https://doi.org/10.1037/a0035250
Farb, N. A., Segal, Z. V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., & Anderson, A. K. (2007). Attending to the present: Mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, 2(4), 313–322. https://doi.org/10.1093/scan/nsm030
Frasure-Smith, N., Lesperance, F., & Talajic, M. (1995). The impact of negative emotions on prognosis following myocardial infarction: is it more than depression? Health Psychol, 14(5), 388–398. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7498109
Fresco, D. M., Moore, M. T., van Dulmen, M. H., Segal, Z. V., Ma, S. H., Teasdale, J. D., & Williams, J. M. (2007). Initial psychometric properties of the experiences questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38(3), 234–246. https://doi.org/10.1016/j.beth.2006.08.003
Fresco, D. M., Segal, Z. V., Buis, T., & Kennedy, S. (2007). Relationship of posttreatment decentering and cognitive reactivity to relapse in major depression. Journal of Consulting and Clinical Psychology, 75(3), 447–455. https://doi.org/10.1037/0022-006x.75.3.447
Frist, M. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II). American Psychiatric Press, Inc.
Garland, E. L., Geschwind, N., Peeters, F., & Wichers, M. (2015). Mindfulness training promotes upward spirals of positive affect and cognition: Multilevel and autoregressive latent trajectory modeling analyses. Frontiers in Psychology, 6, 15. https://doi.org/10.3389/fpsyg.2015.00015
Garrison, K. A., Scheinost, D., Worhunsky, P. D., Elwafi, H. M., Thornhill, T. A., & t., Thompson, E., Saron, C., Desbordes, G., Kober, H., Hampson, M., Gray, J. R., Constable, R. T., Papademetris, X., & Brewer, J. A. (2013). Real-time fMRI links subjective experience with brain activity during focused attention. NeuroImage, 81, 110–118. https://doi.org/10.1016/j.neuroimage.2013.05.030
Garrison, K. A., Zeffiro, T. A., Scheinost, D., Constable, R. T., & Brewer, J. A. (2015). Meditation leads to reduced default mode network activity beyond an active task. Cognitive, Affective, & Behavioral Neuroscience, 15(3), 712–720. https://doi.org/10.3758/s13415-015-0358-3
Germer, C. K., & Neff, K. D. (2018). The Mindful Self-Compassion Workbook: A Proven Way to Accept Yourself, Build Inner Strength, and Thrive. Guilford
Germer, C. K., & Neff, K. D. (2013). Self-compassion in clinical practice. Journal of Clinical Psychology, 69(8), 856–867. https://doi.org/10.1002/jclp.22021
Geschwind, N., Nicolson, N. A., Peeters, F., van Os, J., Barge-Schaapveld, D., & Wichers, M. (2011a). Early improvement in positive rather than negative emotion predicts remission from depression after pharmacotherapy. European Neuropsychopharmacology, 21(3), 241–247. https://doi.org/10.1016/j.euroneuro.2010.11.004
Geschwind, N., Peeters, F., Drukker, M., van Os, J., & Wichers, M. (2011b). Mindfulness training increases momentary positive emotions and reward experience in adults vulnerable to depression: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 79(5), 618–628. https://doi.org/10.1037/a0024595
Giles, J. (2019). Relevance of the no-self theory in contemporary mindfulness. Current Opinion in Psychology, 28, 298–301. https://doi.org/10.1016/j.copsyc.2019.03.016
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cognitive Behaviour Therapy. https://doi.org/10.1080/16506073.2018.1556330
Goldin, P., Ramel, W., & Gross, J. (2009). Mindfulness meditation training and self-referential processing in social anxiety disorder: behavioral and neural effects. Journal of Cognitive Psychotherapy, 23(3), 242–257. https://doi.org/10.1891/0889-8391.23.3.242
Goldstein, B. L., Hayden, E. P., & Klein, D. N. (2015). Stability of self-referent encoding task performance and associations with change in depressive symptoms from early to middle childhood. Cognition and Emotion, 29(8), 1445–1455. https://doi.org/10.1080/02699931.2014.990358
Gotlib, I. H., & Joormann, J. (2010). Cognition and depression: Current status and future directions. Annual Review of Clinical Psychology, 6, 285–312. https://doi.org/10.1146/annurev.clinpsy.121208.131305
Gotlib, I. H., Krasnoperova, E., Yue, D. N., & Joormann, J. (2004). Attentional biases for negative interpersonal stimuli in clinical depression. Journal of Abnormal Psychology, 113(1), 121–135. https://doi.org/10.1037/0021-843X.113.1.121
Gotlib, I. H., Lewinsohn, P. M., & Seeley, J. R. (1995). Symptoms versus a diagnosis of depression: differences in psychosocial functioning. J Consult Clin Psychol, 63(1), 90–100. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=7896995
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006
Guidi, J., Brakemeier, E. L., Bockting, C. L. H., Cosci, F., Cuijpers, P., Jarrett, R. B., Linden, M., Marks, I., Peretti, C. S., Rafanelli, C., Rief, W., Schneider, S., Schnyder, U., Sensky, T., Tomba, E., Vazquez, C., Vieta, E., Zipfel, S., Wright, J. H., & Fava, G. A. (2018). Methodological recommendations for trials of psychological interventions. Psychotherapy and Psychosomatics, 87(5), 276–284. https://doi.org/10.1159/000490574
Hadash, Y., Plonsker, R., Vago, D. R., & Bernstein, A. (2016). Experiential self-referential and selfless processing in mindfulness and mental health: Conceptual model and implicit measurement methodology. Psychological Assessment, 28(7), 856–869. https://doi.org/10.1037/pas0000300
Hahn, B., Harvey, A. N., Gold, J. M., Ross, T. J., & Stein, E. A. (2017). Load-dependent hyperdeactivation of the default mode network in people with schizophrenia. Schizophrenia Research, 185, 190–196. https://doi.org/10.1016/j.schres.2017.01.001
Hallion, L. S., & Ruscio, A. M. (2011). A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychological Bulletin, 137(6), 940–958. https://doi.org/10.1037/a0024355
Hanley, A. W., Nakamura, Y., & Garland, E. L. (2018). The Nondual Awareness Dimensional Assessment (NADA): New tools to assess nondual traits and states of consciousness occurring within and beyond the context of meditation. Psychological Assessment, 30(12), 1625–1639. https://doi.org/10.1037/pas0000615
Harvey, P. O., Lee, J., Horan, W. P., Ochsner, K., & Green, M. F. (2011). Do patients with schizophrenia benefit from a self-referential memory bias? Schizophrenia Research, 127(1–3), 171–177. https://doi.org/10.1016/j.schres.2010.11.011
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd edition). Guilford.
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(2), 169–183. https://doi.org/10.1037/a0018555
Hofmann, S. G., Asmundson, G. J., & Beck, A. T. (2013). The science of cognitive therapy. Behavior Therapy, 44(2), 199–212. https://doi.org/10.1016/j.beth.2009.01.007
Hoge, E. A., Acabchuk, R. L., Kimmel, H., Moitra, E., Britton, W. B., Dumais, T., Ferrer, R. A., Lazar, S. W., Vago, D., Lipsky, J., Schuman-Olivier, Z., Cheaito, A., Sager, L., Peters, S., Rahrig, H., Acero, P., Scharf, J., Loucks, E. B., & Fulwiler, C. (2021). Emotion-related constructs engaged by mindfulness-based interventions: A systematic review and meta-analysis. Mindfulness (n Y), 12(5), 1041–1062. https://doi.org/10.1007/s12671-020-01561-w
Holzel, B. K., Lazar, S., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 8(6), 537–559.
IOM. (2008). Knowing What Works in Health Care: A Roadmap for the Nation (Eden J, B. Wheatley, B. McNeil, & H. Sox, Eds.). Institute of Medicine. National Academies Press
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta.
Kabat-Zinn, J. (2011). Some reflections of the origins of MBSR, skillful means and the trouble with maps. Contemporary Buddhism, 12, 281–306.
Kabat-Zinn, J. (2019). Foreword: Seeds of a necessary global renaissance in the making: The refining of psychology’s understanding of the nature of mind, self, and embodiment through the lens of mindfulness and its origins at a key inflection point for the species. Current Opinion in Psychology. https://doi.org/10.1016/j.copsyc.2019.02.005
Kabat-Zinn, J. (2010). Forward. In D. McCown, D. Reibel, & M. S. Micozzi (Eds.), Teaching mindfulness: a practical guide for clinicians and educators. Springer
Kelley, W. M., Macrae, C. N., Wyland, C. L., Caglar, S., Inati, S., & Heatherton, T. F. (2002). Finding the self? An event-related fMRI study. Journal of Cognitive Neuroscience, 14(5), 785–794. https://doi.org/10.1162/08989290260138672
Kellough, J. L., Beevers, C. G., Ellis, A. J., & Wells, T. T. (2008). Time course of selective attention in clinically depressed young adults: An eye tracking study. Behaviour, Research and Therapy, 46(11), 1238–1243. https://doi.org/10.1016/j.brat.2008.07.004
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M. A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005
Kiken, L. G., Lundberg, K. B., & Fredrickson, B. L. (2017). Being present and enjoying it: Dispositional mindfulness and savoring the moment are distinct, interactive predictors of positive emotions and psychological health. Mindfulness (n Y), 8(5), 1280–1290. https://doi.org/10.1007/s12671-017-0704-3
Komulainen, E., Heikkila, R., Nummenmaa, L., Raij, T. T., Harmer, C. J., Isometsa, E., & Ekelund, J. (2018). Short-term escitalopram treatment normalizes aberrant self-referential processing in major depressive disorder. Journal of Affective Disorders, 236, 222–229. https://doi.org/10.1016/j.jad.2018.04.096
Krueger, R. F., Chentsova-Dutton, Y. E., Markon, K. E., Goldberg, D., & Ormel, J. (2003) A cross-cultural study of the structure of comorbidity among common psychopathological syndromes in the general health care setting. J Abnorm Psychol, 112(3), 437–447. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12943022
Kuster, F., Orth, U., & Meier, L. L. (2012). Rumination mediates the prospective effect of low self-esteem on depression: A five-wave longitudinal study. Personality and Social Psychology Bulletin, 38(6), 747–759. https://doi.org/10.1177/0146167212437250
Lebois, L. A. M., Wolff, J. D., Hill, S. B., Bigony, C. E., Winternitz, S., Ressler, K. J., & Kaufman, M. L. (2019). Preliminary evidence of a missing self bias in face perception for individuals with dissociative identity disorder. Journal of Trauma & Dissociation, 20(2), 140–164. https://doi.org/10.1080/15299732.2018.1547807
LeMoult, J., & Gotlib, I. H. (2019). Depression: A cognitive perspective. Clinical Psychology Review, 69, 51–66. https://doi.org/10.1016/j.cpr.2018.06.008
Lin, Y., Callahan, C. P., & Moser, J. S. (2018). A mind full of self: Self-referential processing as a mechanism underlying the therapeutic effects of mindfulness training on internalizing disorders. Neuroscience & Biobehavioral Reviews, 92, 172–186. https://doi.org/10.1016/j.neubiorev.2018.06.007
Lindahl, J. R., & Britton, W. B. (2019). “I have this feeling of not really being here”: Buddhist meditation and changes in sense of self. Journal of Consciousness Studies, 26(7–8), 157–183.
Lovibond, P. F. (1998). Long-term stability of depression, anxiety, and stress syndromes. J Abnorm Psychol, 107(3): 520–526 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9715586
Lumma, A. L., Valk, S. L., Bockler, A., Vrticka, P., & Singer, T. (2018). Change in emotional self-concept following socio-cognitive training relates to structural plasticity of the prefrontal cortex. Brain and Behavior, 8(4), e00940. https://doi.org/10.1002/brb3.940
Macrae, C. N., Moran, J. M., Heatherton, T. F., Banfield, J. F., & Kelley, W. M. (2004). Medial prefrontal activity predicts memory for self. Cerebral Cortex, 14(6), 647–654. https://doi.org/10.1093/cercor/bhh025
Marsh, L., Edginton, T., Conway, M. A., & Loveday, C. (2018). Positivity bias in past and future episodic thinking: Relationship with anxiety, depression, and retrieval-induced forgetting. Quarterly Journal of Experimental Psychology. https://doi.org/10.1177/1747021818758620
Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1, 167–195. https://doi.org/10.1146/annurev.clinpsy.1.102803.143916
Matt, G. E., Vázquez, C., & Campbell, W. K. (1992). Mood-congruent recall of affectively toned stimuli: A meta-analytic review. Clinical Psychology Review, 12(2), 227–255. https://doi.org/10.1016/0272-7358(92)90116-p
Mennin, D. S., & Fresco, D. M. (2013). What, Me Worry and Ruminate About DSM-5 and RDoC? The importance of targeting negative self-referential processing. Clinical Psychology (new York), 20(3), 258–267. https://doi.org/10.1111/cpsp.12038
Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128(4), 638–662. https://doi.org/10.1037/0033-2909.128.4.638
Morone, N. E., Moore, C. G., & Greco, C. M. (2017). Characteristics of adults who used mindfulness meditation: United States, 2012. Journal of Alternative and Complementary Medicine, 23(7), 545–550. https://doi.org/10.1089/acm.2016.0099
Moulds, M. L., Kandris, E., & Williams, A. D. (2007). The impact of rumination on memory for self-referent material. Memory, 15(8), 814–821. https://doi.org/10.1080/09658210701725831
Nabi, H., Kivimaki, M., De Vogli, R., Marmot, M. G., & Singh-Manoux, A. (2008). Positive and negative affect and risk of coronary heart disease: Whitehall II prospective cohort study. British Medical Journal, 337, a118. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18595926
Nabi, H., Koskenvuo, M., Singh-Manoux, A., Korkeila, J., Suominen, S., Korkeila, K., Vahtera, J., & Kivimaki, M. (2009). Low Pessimism Protects Against Stroke. The Health and Social Support (HeSSup) Prospective Cohort Study. Stroke, Epub-ahead of print. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19892995
Nejad, A. B., Fossati, P., & Lemogne, C. (2013). Self-referential processing, rumination, and cortical midline structures in major depression. Frontiers in Human Neuroscience, 7, 666. https://doi.org/10.3389/fnhum.2013.00666
Norbury, R., Mackay, C. E., Cowen, P. J., Goodwin, G. M., & Harmer, C. J. (2008). The effects of reboxetine on emotional processing in healthy volunteers: An fMRI study. Molecular Psychiatry, 13(11), 1011–1020. https://doi.org/10.1038/sj.mp.4002091
Northoff, G., Heinzel, A., de Greck, M., Bermpohl, F., Dobrowolny, H., & Panksepp, J. (2006). Self-referential processing in our brain–a meta-analysis of imaging studies on the self. NeuroImage, 31(1), 440–457. https://doi.org/10.1016/j.neuroimage.2005.12.002
Onken, L. S., Carroll, K. M., Shoham, V., Cuthbert, B. N., & Riddle, M. (2014). Reenvisioning Clinical Science: Unifying the Discipline to Improve the Public Health. Clinical Psychological Science, 2(1), 22–34. https://doi.org/10.1177/2167702613497932
Orth, U., & Robins, R. W. (2013). Understanding the link between low self-esteem and depression. Current Directions in Psychological Science, 22(6), 455–460. https://doi.org/10.1177/0963721413492763
Pek, J., Wong, O., & Wong, A. C. M. (2018). How to address non-normality: A taxonomy of approaches, reviewed, and illustrated. Frontiers in Psychology, 9(2104). https://doi.org/10.3389/fpsyg.2018.02104
Phillips, W. J., Hine, D. W., & Thorsteinsson, E. B. (2010). Implicit cognition and depression: A meta-analysis. Clinical Psychology Review, 30(6), 691–709. https://doi.org/10.1016/j.cpr.2010.05.002
Randal, C., Pratt, D., & Bucci, S. (2016). Mindfulness and Self-esteem: A systematic review. Mindfulness, 6, 1366–1378.
Reidy, J. (2004). Trait anxiety, trait depression, worry, and memory. Behaviour, Research and Therapy, 42(8), 937–948. https://doi.org/10.1016/j.brat.2003.07.005
Roberts-Wolfe, D., Sacchet, M. D., Hastings, E., Roth, H., & Britton, W. (2012). Mindfulness training alters emotional memory recall compared to active controls: Support for an emotional information processing model of mindfulness. Frontiers in Human Neuroscience, 6, 15. https://doi.org/10.3389/fnhum.2012.00015
Robins, C. J., Keng, S. L., Ekblad, A. G., & Brantley, J. G. (2012). Effects of mindfulness-based stress reduction on emotional experience and expression: A randomized controlled trial. Journal of Clinical Psychology, 68(1), 117–131. https://doi.org/10.1002/jclp.20857
Rodriguez, A. J., Holleran, S. E., & Mehl, M. R. (2010). Reading between the lines: The lay assessment of subclinical depression from written self-descriptions. Journal of Personality, 78(2), 575–598. https://doi.org/10.1111/j.1467-6494.2010.00627.x
Rush, A. J., Kraemer, H. C., Sackeim, H. A., Fava, M., Trivedi, M. H., Frank, E., Ninan, P. T., Thase, M. E., Gelenberg, A. J., Kupfer, D. J., Regier, D. A., Rosenbaum, J. F., Ray, O., Schatzberg, A. F., & Force, A. T. (2006). Report by the ACNP Task Force on response and remission in major depressive disorder. Neuropsychopharmacology, 31(9), 1841–1853. https://doi.org/10.1038/sj.npp.1301131
Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The Inventory of Depressive Symptomatology (IDS): psychometric properties. Psychological Medicine, 26(3): 477–486. https://www.ncbi.nlm.nih.gov/pubmed/8733206
Ryan, R., & Rigby, C. (2015). Did the Buddha have a self? no-self, self, and mindfulness in Buddhist thought and western psychologies. In K. Brown, J. Creswell, & R. Ryan (Eds.), Handbook of mindfulness: Theory, research and practice (pp. 245–265). Guilford.
Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R., & Buis, T. (2006). Cognitive reactivity to sad mood provocation and the prediction of depressive relapse. Archives of General Psychiatry, 63(7), 749–755. https://doi.org/10.1001/archpsyc.63.7.749
Segal, Z. V., Anderson, A. K., Gulamani, T., Dinh Williams, L. A., Desormeau, P., Ferguson, A., Walsh, K., & Farb, N. A. S. (2019). Practice of therapy acquired regulatory skills and depressive relapse/recurrence prophylaxis following cognitive therapy or mindfulness based cognitive therapy. Journal of Consulting and Clinical Psychology, 87(2), 161–170. https://doi.org/10.1037/ccp0000351
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse.
Shahar, B., Britton, W. B., Sbarra, D. A., Figueredo, A. J., & Bootzin, R. R. (2010). Mechanisms of change in mindfulness-based cognitive therapy for depression: Preliminary evidence from a randomized controlled trial. International Journal of Cognitive Therapy, 3(4), 402–418. https://doi.org/10.1521/ijct.2010.3.4.402
Sheline, Y. I., Barch, D. M., Price, J. L., Rundle, M. M., Vaishnavi, S. N., Snyder, A. Z., Mintun, M. A., Wang, S., Coalson, R. S., & Raichle, M. E. (2009). The default mode network and self-referential processes in depression. Proceedings of the National Academy of Sciences, 106(6), 1942–1947. https://doi.org/10.1073/pnas.0812686106
Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195152968.001.0001
Sorg, C., Riedl, V., Muhlau, M., Calhoun, V. D., Eichele, T., Laer, L., Drzezga, A., Forstl, H., Kurz, A., Zimmer, C., & Wohlschlager, A. M. (2007). Selective changes of resting-state networks in individuals at risk for Alzheimer’s disease. Proceedings of the National Academy of Sciences, 104(47), 18760–18765. https://doi.org/10.1073/pnas.0708803104
Sui, J., & Humphreys, G. W. (2015). The Integrative Self: How self-reference integrates perception and memory. Trends in Cognitive Sciences, 19(12), 719–728. https://doi.org/10.1016/j.tics.2015.08.015
Symons, C. S., & Johnson, B. T. (1997). The self-reference effect in memory: a meta-analysis. Psychological bulletin, 121(3), 371–394. https://www.ncbi.nlm.nih.gov/pubmed/9136641
Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W., & Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187
Taves, A. (2020). Mystical and other alterations in sense of self: an expanded framework for studying nonordinary experiences. Perspectives on Psychological Science, 15(3), 669–690. https://doi.org/10.1177/1745691619895047
Taylor, V. A., Daneault, V., Grant, J., Scavone, G., Breton, E., Roffe-Vidal, S., Courtemanche, J., Lavarenne, A. S., Marrelec, G., Benali, H., & Beauregard, M. (2013). Impact of meditation training on the default mode network during a restful state. Social Cognitive and Affective Neuroscience, 8(1), 4–14. https://doi.org/10.1093/scan/nsr087
Teasdale, J. D., & Chaskalson, M. (2011a). How does mindfulness transform suffering? I: The nature and origins of dukkha. Contemporary Buddhism, 12, 89–102.
Teasdale, J. D., & Chaskalson, M. (2011b). How does mindfulness transform suffering? II: The transformation of dukkha. Contemporary Buddhism, 12, 103–124.
Tsai, J. L., Knutson, B., & Fung, H. H. (2006). Cultural variation in affect valuation. Journal of Personality and Social Psychology, 90(2), 288–307. https://doi.org/10.1037/0022-3514.90.2.288
Van Dam, N. T., Sheppard, S. C., Forsyth, J. P., & Earleywine, M. (2011). Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. Journal of Anxiety Disorders, 25(1), 123–130. https://doi.org/10.1016/j.janxdis.2010.08.011
van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., Fjorback, L. O., & Piet, J. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26–39. https://doi.org/10.1016/j.cpr.2015.02.001
van Vugt, M. K., Hitchcock, P., Shahar, B., & Britton, W. (2012). The effects of mindfulness-based cognitive therapy on affective memory recall dynamics in depression: A mechanistic model of rumination. Frontiers in Human Neuroscience, 6, 257. https://doi.org/10.3389/fnhum.2012.00257
Vignaud, P., Donde, C., Sadki, T., Poulet, E., & Brunelin, J. (2018). Neural effects of mindfulness-based interventions on patients with major depressive disorder: A systematic review. Neuroscience & Biobehavioral Reviews, 88, 98–105. https://doi.org/10.1016/j.neubiorev.2018.03.004
Walach, H., Buchheld, N., Buttenmuller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindfulness—the Freiburg Mindfulness Inventory (FMI). Personality and Individual Differences, 40, 1543–1555.
Walsh, R., & Shapiro, S. L. (2006). The meeting of meditative disciplines and Western psychology: A mutually enriching dialogue. American Psychologist, 61(3), 227–239. https://doi.org/10.1037/0003-066x.61.3.227
Wardenaar, K. J., Giltay, E. J., van Veen, T., Zitman, F. G., & Penninx, B. W. (2012). Dimensions of the inventory of depressive symptomatology as predictors of the course of depressive and anxiety disorders. Journal of Psychiatric Research, 46(12), 1655–1661. https://doi.org/10.1016/j.jpsychires.2012.08.024
Watkins, E. R. (2015). Psychological treatment of depressive rumination. Current Opinion in Psychology, 4, 32–36.
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of personality and social psychology, 54(6), 1063–1070. https://www.ncbi.nlm.nih.gov/pubmed/3397865
Williams, J. M. (2010). Mindfulness and psychological process. Emotion, 10(1), 1–7. https://doi.org/10.1037/a0018360
Williams, A. D., & Moulds, M. L. (2010). The impact of ruminative processing on the experience of self-referent intrusive memories in dysphoria. Behavior Therapy, 41(1), 38–45. https://doi.org/10.1016/j.beth.2008.12.003
Wolf, C., & Serpa, J. (2015). A Clinician's Guide to teaching Mindfulness. New Harbinger.
Woods, S., Rockman, P., & Collins, E. (2019). Mindfulness-Based Cognitive Therapy: Embodied Presence & Inquiry in Practice. New Harbinger.
Zhu, Y., Zhang, L., Fan, J., & Han, S. (2007). Neural basis of cultural influence on self-representation. NeuroImage, 34(3), 1310–1316. https://doi.org/10.1016/j.neuroimage.2006.08.047
Funding
This work was supported by the National Institutes of Health (Grant K23-AT006328-01A1); the National Institutes of Health (NIH) Science of Behavior Change Common Fund Program through an award administered by the National Center for Complementary and Integrative Health (Grant UH2AT009145); the Mind and Life Institute; Sam Harris and the Brown University Contemplative Studies Initiative. The views presented here are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
W.B.B. and J.R.L receive payments for providing trainings and education in scientific literacy, meditation safety, and trauma-informed mindfulness. W.B.B. and J.R.L are nominally affiliated with the Mindfulness Center at Brown University which generates income by offering mindfulness classes to the public. W.B.B. is a MBSR and MBCT teacher and has received financial compensation for this role. W.B.B is the founder of Cheetah House, a RI non-profit organization that provides information about meditation-related difficulties, individual consultations, and support groups, as well as educational trainings to meditation teachers, clinicians, educators and mindfulness providers. This interest has been disclosed to and is being managed by Brown University, in accordance with its Conflict of Interest and Conflict of Commitment policies.
Ethical Approval
This study was carried out in accordance with the provisions of the World Medical Association Declaration of Helsinki.
Informed Consent
All participants provided written, informed consent approved by the Brown University Institutional Review Board.
Animal Rights
No animal studies were carried out by the authors for this paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Alejandre-Lara, A.L., Canby, N.K., Wesbecher, K.D. et al. How do Mindfulness-Based Programs Improve Depression Symptoms: Selflessness, Valence, or Valenced Self?. Cogn Ther Res 46, 668–685 (2022). https://doi.org/10.1007/s10608-021-10287-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-021-10287-5
Keywords
- Mindfulness
- Depression
- Mechanism
- Self-related processing
- Emotional valence