Beginning to Practice Mindfulness
The 145 participants who had attended a face-to-face course or followed a course from a book or online provided further information about the course and their experience. Sixteen participants (11%) attended courses delivered by the NHS: 14 face-to-face and two online. Sixty-eight people (46.9%) paid for their face-to-face taught course and eight people (5.5%) paid for their online course. Most participants (90; 62.1%) attended or followed courses consisting of eight sessions. One hundred and thirty-five participants answered the question “Why did you attend the mindfulness course?” Responses were categorised and can be found in Table 2 below (some participants gave more than one reason).
Falling asleep during practice was common: 62 people (42.8%) reported falling asleep during practices in the course sessions and 49 of these were attendees of a face-to-face course. Of these 62 participants, 54 (87.1%) said they fell asleep during the body scan (42 were attendees of a face-to-face course). Ninety-six people (66.2%) reported falling asleep during their home practice (77 were attendees of a face-to-face course). One hundred and thirty-nine participants answered the question about home practice and 22 (15.8%) said they completed the home practice all of the time, 72 (51.8%) said they completed the home practice most of the time, and 34 (24.5%) said they completed the home practice some of the time. Eighteen participants (12.9%) said they did not feel able to discuss difficulties with home practice with the course teachers compared to 107 (77%) who did feel able to discuss this. Fifty-nine participants (53 who attended a face-to-face taught course) were offered a reunion/top-up session, and 35 (32 who attended a face-to-face taught course) attended a reunion/top-up session. One hundred and thirty-five people (96.4%) said they found the mindfulness course helpful, compared to five (3.6%) who did not (five people did not answer this question). When asked if they thought the mindfulness course made any difference to their life, 141 participants answered as follows: significant positive change: 90 (63.8%), some positive change: 46 (32.6%), no change: three (2.1%), and some negative change: two (1.4%).
Of the 218 participants, 198 reported that they were currently practicing formal mindfulness, and 207 reported that they were currently practicing informal mindfulness. In a free-text comment field, some participants gave examples of their informal mindfulness practice. These included washing the dishes, eating, driving, brushing teeth, walking the dog, drinking coffee, and watching a wild bird or flower. Self-reported frequency of formal and informal mindfulness practice is illustrated in Fig. 2 below. As can be seen, most participants reported practicing several times a week or every day, indicating a regular practice. Twenty-four participants (12.1%) practiced formal mindfulness for 45 min or longer at a time, 56 participants (28.3%) practiced for 30 min, 68 participants (34.3%) practiced for 20 min, and 50 (25.3%) practiced for 10 min at a time.
For the purpose of inferential statistics, frequency of practice was coded from 0 (not practicing) to 5 (practicing every day) and a Mann-Whitney test revealed that there was no significant difference in the frequency of formal mindfulness practice between those who had attended a face-to-face taught course (Mdn = 4) and those who had not attended a face-to-face taught course (Mdn = 4), U = 5346.50, z = − 1.29, ns, r = − 0.09.
Mindfulness Practice, Wellbeing, and Psychological Flexibility
The mean wellbeing (SWEMWBS) score for the sample of 208 participants was 23.75 (SD = 3.46, range 15.32–35), and the mean psychological flexibility (AAQ-II) score was 19.08 (SD = 7.60, range 7–42). These scores are consistent with norms of 23.7 for SWEMWBS (Ng Fat et al. 2016) and 18.51 for the AAQ-II (Bond et al. 2011). All three aspects of mindfulness practice significantly positively correlated with each other, and wellbeing was significantly negatively correlated with psychological flexibility (see Table 3). Negative values are due to lower AAQ-II scores indicating greater acceptance and higher scores indicating greater experiential avoidance.
Hierarchical regression tested the relationship between mindfulness practice and wellbeing. For model 1, frequency of formal mindfulness practice (t(204) = 2.098, β = .159, SE = .165, B = .345, p = .037) and frequency of informal practice (t(204) = 3.72, β = .254, SE = .154, B = .574, p < .001) were significantly related to wellbeing, and frequency of informal mindfulness was the most important variable in this model. Duration of formal mindfulness practice (t(204) = 1.62, β = .118, SE = .212, B = .344, p = .106) was not significantly related to wellbeing. Model 2 included mindfulness teacher status and duration of mindfulness practice in years. Neither of these variables were significantly related to wellbeing (teacher status: t(202) = 1.49, β = .110, SE = .598, B = .892, p = .138; years of practice: t(202) = .459, β = .033, SE = .037, B = .017, p = .647). However, including these variables affected the relationships between wellbeing and frequency of formal mindfulness practice (t(202) = 1.96, β = .149, SE = .166, B = .324, p = .052) and wellbeing and duration of formal mindfulness practice (t(202) = 1.25, β = .093, SE = .217, B = .272, p = .212), resulting in there no longer being a significant relationship between wellbeing and frequency of formal mindfulness practice. In model 2, frequency of informal mindfulness practice was the only variable significantly related to wellbeing (t(202) = 3.18, β = .222, SE = .158, B = .503, p = .002). The combined influence of mindfulness practice (model 1) accounted for 15.9% of the variation in wellbeing (R2 = .159, adjusted R2 = .147). This increased slightly to 17.3% (R2 = .173, adjusted R2 = .153) when the other variables were added (model 2). Although ANOVA results indicated that both models were significant predictors of wellbeing (p = .000), model 1 (F = 12.890) was a better predictor than model 2 (F = 8.477). Both models showed small effect sizes (model 1: .198; model 2: .209).
Hierarchical regression also tested the relationship between mindfulness practice and psychological flexibility. For model 1, frequency of informal mindfulness practice (t(204) = − 3.395, β = − .241, SE = .352, B = − 1.197, p = .001) was significantly related to psychological flexibility. Frequency of formal practice (t(204) = − .446, β = − .035, SE = .376, B = − .168, p = .656) and duration of formal mindfulness practice (t(204) = − 1.296, β = − .098, SE = .484, B = − .627, p = .197) were not significantly related to psychological flexibility. Again for model 2, neither mindfulness teacher status (t(202) = − 1.161, β = − .089, SE = 1.36, B = − 1.580, p = .247) nor years of mindfulness practice (t(202) = − 1.478, β = − .111, SE = .084, B = − .124, p = .141) were significantly related to psychological flexibility. Adding these variables to the model did not significantly affect the sizes of the relationships between psychological flexibility and the three aspects of mindfulness practice. Again, frequency of informal mindfulness practice was the only practice variable significantly related to psychological flexibility (t(202) = − 2.763, β = − .201, SE = .360, B = − .995, p = .006). The combined influence of mindfulness practice (model 1) accounted for 8.7% of the variation in psychological flexibility (R2 = .087, adjusted R2 = .074). This increased to 11.2% (R2 = .112, adjusted R2 = .090) when the other variables were added. Although ANOVA results indicated that both models were significant predictors of psychological flexibility, model 1 (F = 6.494, p < .001) was a better predictor than model 2 (F = 5.094, p < .001). However, the models only explained that a small amount of the variance and effect sizes were small (model 1: .095; model 2: .126).
Challenges and Support for Mindfulness Practice
The 198 participants practicing formal mindfulness were asked which practices from those listed they completed regularly. The number of participants that selected each practice is as follows: body scan (89, 44.9%), sitting practice (125, 63.1%), breathing space (112, 56.6%), mindful movement (52, 26.3%), all of the above (31, 15.7%), and other (34, 17.2%). In the free-text option for “Other,” participants stated a variety of additional practices including mindfulness of sound and loving-kindness meditation. Seventy-six participants (38.4%) said that there were some practices they disliked or found difficult and so did not do. The most common of those listed by participants were the body scan (27, 35.5%) and mindful movement or walking (18, 23.7%). Participants were then asked to select the options that best described their experiences of mindfulness practice, and responses were as follows: easy (57, 28.8%), interesting (97, 49%), practice reluctantly (40, 20.2%), irritating (31, 15.7%), practice willingly (123, 62.1%), difficult (72, 36.4%), enjoyable (100, 50.5%), boring (27, 13.6%), relaxing (127, 64.1%), ok (45, 22.7%), it is what it is (90, 45.5%), and blissful (33, 16.7%). There were a number of free-text comments about practice varying from day to day. Other comments touched on the usefulness of practice as well as difficulties with practice including perceptions of how practice “should be,” such as “can occasionally be hard to stay sitting if the mind is pre-occupied - useful still to sit and be with boredom or irritation and come back to focusing anchor.” “Can sometimes make me aware of things I hadn’t known I was feeling, which can annoy me when I don’t feel ready to deal with them emotionally.” “Sometimes guilt-inducing because I think I’m not doing them right and I should be better by now.” “Each meditation is different. Sometimes being with the uncomfortable is challenging. Whatever the moment brings … can be blissful and easy one day then difficult and uncomfortable the next.”
Falling Asleep During Mindfulness Practice
Of the 198 participants currently practicing formal mindfulness, 112 (56.6%) reported falling asleep during practice. Seventy of these (62.5%) said that they did not fall asleep regularly and 11 (9.8%) said that they had a medical condition that they thought made them more likely to fall asleep during practice. Participants reported falling asleep most frequently during the body scan (67, 57.8%) and breathing/sitting practice (23, 19.8%). One-hundred and five participants answered the open question “How do you feel about falling asleep?” Responses were analysed in line with Elo and Kynga (2008) and categorised as follows: intended to/find it helpful for getting to sleep (6, 5.7%), positive response (6, 5.7%), accepting response (71, 67.6%), negative response (15, 14.3%), combination of acceptance, and negative response (7, 6.7%). Some participants whose responses fit within the “positive” or “accepting” categories commented on the beneficial effects of falling asleep, e.g. “Fine, it has helped me to learn to fall asleep during bouts of insomnia!” and “Love it. I always wake rested even more than if I lay down for a rest.” When responses to questions about sleep were broken down according to how people first began to practice mindfulness, the types of response given appeared to be proportionate across the groups. A breakdown can be found in Supplementary material (S2).
Factors that Support Participants to Practice Mindfulness
Participants were asked to select all that applied from a range of options to describe how their current practice is supported. One-hundred and ninety-six participants responded as follows: CD (72, 36.7%), app (69, 35.2%), self-guided (143, 73%), guided by others (21, 10.7%), practice in a group with guidance (35, 17.9%), and practice in a group without guidance (13, 6.6%). Responses to the open question of what is or would be supportive were analysed in line with Elo and Kynga (2008); four main categories of response were identified. Some responses fit within more than one category. The categories were “practical resources” (97), “time/routine” (36), “support from others” (85), and “attitudes and beliefs” (29).
Participants stated tools such as apps, CDs, and emails from websites helped to support practice. Evidence and reminders that mindfulness can be helpful were seen as supportive. Some participants created their own practice reminders in the home or using cues from their environment. For example: “a reminder bracelet, pic on my desk, the school bell is when I breathe etc.” “Following mindful accounts on twitter & newsletters.” “An understanding of the basis for mindfulness and examples of success in using mindfulness more than it made me feel better.” “CDs, downloads, and apps are great, a nice voice is important either male or female, good books with website/links are very useful.”
Participants highlighted the importance of finding time to practice and stated that this wasn’t always easy. Being able to incorporate practice into a daily routine or form a routine for practice was also important.
Support from Others
Being part of a mindfulness community was highly valued. Fourteen participants explicitly stated that they attend regular group practice sessions or course refresher/reunion sessions in order to support their practice. Contact with mindfulness teachers, attending workshops, group practice sessions, and talking to others who practice all helped to support ongoing mindfulness practice. Support from friends, family, and the workplace was also seen as important. For example: “I buddy up with a friend and we text each other when we have completed a formal practice. I taught her mindfulness and now offer informal supervision. This monthly connection keeps me on track ….” “Regular opportunities to formally practice with others and share ideas or experiences about practice. It inspires and reinvigorates.” “Mindfulness at workplace, in a work culture where mindfulness is valued.” “More connection with community of other practitioners.”
Attitudes and Beliefs
Some participants stated that their own beliefs and experience supported them to continue to practice; feelings during and following practice and feeling a benefit. Attitudes of acceptance and kindness were also important, particularly if practice had lapsed. For example: “the experience of life being easier, more fulfilling, having resources to cope with difficulty when I practice.” “Knowing the benefits I gain from doing. Knowing that if I stop it’s like a muscle and weakens. Knowing that I can always begin again, which is very kindly and forgiving.” “Knowing that you can do anything mindfully and you can’t get it wrong.” “The encouragement to trust that every moment can be mindful without having to use a formal approach.”