ArticlePDF Available

Phenomenological fingerprints of four meditations: Differential state changes in affect, mind-wandering, meta-cognition and interoception before and after daily practice across nine months of training.

Authors:

Abstract and Figures

Despite increasing interest in the effects of mental training practices such as meditation, there is much ambiguity regarding whether and to what extent the various types of mental practice have differential effects on psychological change. To address this gap, we compare the effects of four common meditation practices on measures of state change in affect, mind-wandering, meta-cognition, and interoception. In the context of a 9-month mental training program called the ReSource Project, 229 mid-life adults (mean age 41) provided daily reports before and after meditation practice. Participants received training in the following three successive modules: the first module (presence) included breathing meditation and body scan, the second (affect) included loving-kindness meditation, and the third (perspective) included observing-thought meditation. Using multilevel modeling, we found that body scan led to the greatest state increase in interoceptive awareness and the greatest decrease in thought content, loving-kindness meditation led to the greatest increase in feelings of warmth and positive thoughts about others, and observing-thought meditation led to the greatest increase in meta-cognitive awareness. All practices, including breathing meditation, increased positivity of affect, energy, and present focus and decreased thought distraction. Complementary network analysis of intervariate relationships revealed distinct phenomenological clusters of psychological change congruent with the content of each practice. These findings together suggest that although different meditation practices may have common beneficial effects, each practice can also be characterized by a distinct short-term psychological fingerprint, the latter having important implications for the use of meditative practices in different intervention contexts and with different populations.
This content is subject to copyright. Terms and conditions apply.
ORIGINAL PAPER
Phenomenological Fingerprints of Four Meditations: Differential
State Changes in Affect, Mind-Wandering, Meta-Cognition,
and Interoception Before and After Daily
Practice Across 9 Months of Training
Bethany E. Kok
1
&Tani a S i n g e r
1
Published online: 19 August 2016
#The Author(s) 2016. This article is published with open access at Springerlink.com
Abstract Despite increasing interest in the effects of mental
training practices such as meditation, there is much ambiguity
regarding whether and to what extent the various types of
mental practice have differential effects on psychological
change. To address this gap, we compare the effects of four
common meditation practices on measures of state change in
affect, mind-wandering, meta-cognition, and interoception. In
the context of a 9-month mental training program called the
ReSource Project, 229 mid-life adults (mean age 41) provided
daily reports before and after meditation practice. Participants
received training in the following three successive modules:
the first module (presence) included breathing meditation and
body scan, the second (affect) included loving-kindness med-
itation, and the third (perspective) included observing-thought
meditation. Using multilevel modeling, we found that body
scan led to the greatest state increase in interoceptive aware-
ness and the greatest decrease in thought content, loving-
kindness meditation led to the greatest increase in feelings of
warmth and positive thoughts about others, and observing-
thought meditation led to the greatest increase in meta-
cognitive awareness. All practices, including breathing medi-
tation, increased positivity of affect, energy, and present focus
and decreased thought distraction. Complementary network
analysis of intervariate relationships revealed distinct
phenomenological clusters of psychological change congru-
ent with the content of each practice. These findings together
suggest that although different meditation practices may have
common beneficial effects, each practice can also be charac-
terized by a distinct short-term psychological fingerprint, the
latter having important implications for the use of meditative
practices in different intervention contexts and with different
populations.
Keywords Meditation .Meta-cognitive awareness .
Decentering .Interoception .Affect .Multilevel modeling
Introduction
In recent years, the potential effects of mental training on
well-being, brain, health, and behavior have become a fo-
cus of both popular and scientific interest. A wide variety
of training programs now exist that offer secularized med-
itation training, comprised of standardized protocols with
instructioninavarietyofcontemplative practices (Kabat-
Zinn 1990), often in combination with other forms of men-
tal training such as cognitive-behavioral therapy (Fjorback
et al. 2011). Mental training has promise, both as a poten-
tial treatment for mental disorders from schizophrenia
(Johnson et al. 2011) to PTSD (Lang et al. 2012)todepres-
sion and anxiety (Strauss et al. 2014), among others, and as
a method for improving quality of life in individuals not
diagnosed with a disorder (Chiesa and Serretti 2009).
Initial research on the benefits of secularized meditation
programs rested on comparisons to passive control groups
or on comparing pre-meditation and post-meditation ef-
fects in the same participants with no control (Ospina
et al. 2008). Such studies found significant effects on
physical and mental health, attention, stress reduction,
Electronic supplementary material The online version of this article
(doi:10.1007/s12671-016-0594-9) contains supplementary material,
which is available to authorized users.
*Bethany E. Kok
bethkok@cbs.mpg.de
1
Department of Social Neuroscience, Max Planck Institute for Human
Cognitive and Brain Sciences, Stephanstraße 1A,
04103 Leipzig, Germany
Mindfulness (2017) 8:218231
DOI 10.1007/s12671-016-0594-9
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
and even brain activity (Chiesa and Serretti 2010). Other
studies focused on defining the subjective experience, or
phenomenology, of meditation, sometimes linking phe-
nomenological measures to objective indices of neural or
physiological activity (Lutz and Thompson 2003).
Meditation, like sports, refers to many different types of
activities that can vary greatly in content, focus, effort, com-
plexity, and duration. Widely studied secular mental training
programs like Mindfulness-Based Stress Reduction (MBSR)
or Mindfulness-Based Cognitive Therapy (MBCT) combine
many different mental practices, making it impossible to iso-
late the effects of any one specific practice (Kabat-Zinn 1990;
Williams et al. 2014). Furthermore, meditation is commonly
performed in a specific context which can have effects inde-
pendent of practice content. When meditative practices are
compared to active control groups rather than waitlist controls
or pre-post comparisons without a control group, findings of
specific effects for meditation often become smaller and more
bounded (Feldman et al. 2010;Kuykenetal.2015;MacCoon
et al. 2012; Obasi et al. 2013). Similarly, due to the intensive
measurement requirements of phenomenological research, the
vast majority of phenomenological studies focus only on the
phenomenological space of one meditative practice, without
direct comparison to others (for an exception, see
Louchakova-Schwartz (2013)).
Four commonly studied meditative practices are breathing
meditation, body scan, loving-kindness meditation, and
observing-thought meditation. These practices are drawn
mostly from the Buddhist contemplative traditions, although
many other traditions employ similar exercises. Focusing on
the breath is a meditation aimed at stabilizing attention and the
mind; practitioners learn to direct attention to the breath in an
intentional way, to monitor the direction of attention and de-
tect when the mind wanders, and to return attention to the
breath when mind-wandering is detected. As the practice
teaches stable attention, an ability required for meditation, it
is often taught to beginners yet remains central to the practices
of many experienced meditators (Hart 1987;Sakyong2003).
In their review of the literature, Lutz et al. (2008) categorized
focus on breath as a type of focused attention meditation and
linked it to changes in attentional processing. For example,
after practicing attentional focus meditation, experienced
Tibetan Buddhist monks were able to perceive, as one stable
percept, two dissimilar images presented to separate eyes; this
effect did not occur after the same monks practiced compas-
sion meditation (Carter et al. 2005).
The practice of body scan involves extending awareness to
each individual part of the body in turn, typically starting at
the head (Kabat-Zinn 1990). Practitioners focus on directing
their attention exclusively toward the targeted body part and
observing the sensations in that part. Body scan is an element
of MBSR and is another kind of focused attention meditation,
this time using different parts of the body as attentional
objects. Body scan practice, in combination with focusing
on the breath, improves interoceptive sensitivity and accuracy
and also trains attentional control, as the meditator constantly
monitors the object of attention and returns attention to the
targeted body part if the mind wanders (Mirams et al. 2013).
Loving-kindness meditation is a practice that focuses on
the cultivation of benevolence, love, and care toward others
and the self (Salzberg 2005). Participants strengthen feelings
of warmth and care through the visualization of a close loved
person. Participants sequentially extend these feelings toward
themselves, a close person, a neutral person, a person whom
they dislike or have difficulties with, and finally toward
strangers and human beings in general. Longitudinal studies
comparing 8 weeks of loving-kindness meditation to a waitlist
control have found that meditators increase in trait positive
emotions (Fredrickson et al. 2008; Kok et al. 2013) and feel-
ings of closeness to others (Kok et al. 2013) but do not change
in negative emotions. There is also evidence that loving-
kindness meditation induces neurological and physiological
changes; 1 week of training in combined loving-kindness
meditation and compassion increased neural activity in net-
works associated with positive affect and affiliation, relative to
an active memory control group (Klimecki et al. 2013,2014;
Singer and Klimecki 2014).
Observing-thought meditation teaches Bdecentering,^a
meta-cognitive process allowing thoughts to arise and fall
without identifying with or becoming absorbed in their con-
tent or emotions. Learning to observe thoughts is an element
of mindfulness meditation and is taught in courses including
MBSR and MBCT (Fjorback and Walach 2012). Observing-
thought meditation training cultivates meta-cognitive aware-
ness of thoughts via two different meta-cognitive skills, taught
sequentially. First, participants learned to categorize upcom-
ing thoughts with labels such as Bpast,^Bfuture,^Bpositive^
or Bnegative,^and Bself^or Bother.^Then, participants
learned to observe thoughts coming and going without
reacting or engaging with the thoughts. Results of a recent
empirical study suggest that training in observing-thought
meditation has cognitive effects; compared to both body scan
and mindful yoga, the observing-thought meditation practice
of Bsitting meditation^was associated with the greatest im-
provement in non-judging of thoughts (Sauer-Zavala et al.
2013). The opposite of decentering, persistent identification
and enmeshment with thoughts, is known as rumination and is
associated with a variety of negative mental health outcomes
(Olatunji et al. 2013). Mindfulness meditation including an
observing-thought component effectively reduced rumination
relative to both relaxation training and measurement control
groups (Jain et al. 2007).
These four meditative practices appear to have psycholog-
ical and physiological effectswhencomparedtowaitlist
control groups or to active non-meditative controls. There
are also hints of practice-specific effects for breathing
Mindfulness (2017) 8:218231 219
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
meditation and observing thoughts, compared to other med-
itative practices. Overall, however, while these four medi-
tative practices have distinct conceptual bases and appear in
theoretical work as distinct practices, there is no empirical
evidence to directly differentiate them.
This study systematically investigates the common and dif-
ferential state effects of these four meditation practices across
dimensions of subjective experience commonly targeted by
meditation, affect, mind-wandering, content of thoughts, and
meta-cognitive and body awareness. Body scan and breathing
meditation should most effectively increase feelings of presence
and body awareness and decrease distraction by thoughts.
Loving-kindness meditation should most effectively increase
positivity of affect and feelings of warmth, as well as positive
and other-focused thoughts. Finally, observing-thought medita-
tion should not change the content of thought or decrease the
amount of thoughts but should most effectively increase meta-
cognitive awareness of thought contents and processes and de-
crease distraction by thoughts. In addition, we hypothesize that
loving kindness will be more effective after 3 months of body
scan and breathing practice. We also conducted exploratory
network analyses of the interrelationships among the various
outcome measures (Borsboom and Cramer 2013).
Method
Participants
Participants were recruited through flyers, radio and newspa-
per advertisements, and local news coverage in two major
German cities. Potential participants attended one of multiple
evening information sessions offered by the principal investi-
gator (Singer), then indicated their interest in participating via
a website. Potential participants were then sent a battery of
screening questionnaires designed to identify individuals from
vulnerable populations (underage, pregnant or nursing, suffer-
ing from mental or physical illness), individuals who would be
unable to complete the behavioral or neurological measure-
ment portions of the study, and individuals with previous med-
itation experience, all of whom were excluded from the pres-
ent study. More details concerning participant recruitment,
screening, and demographics in the ReSource Project are
available in the online Supplementary material.
The sample at start of data collection included 80 participants
in training cohort 1 (TC1), 81 participants in training cohort 2
(TC2),and81participantsintrainingcohort3(TC3).Thethree
training cohorts did not differ significantly in gender, age, or
personality/mental health as assessed by a wide range of trait
measures (listed in Singer et al. (2016), Appendix C2). Of the
initial sample, 13 did not complete any meditation sessions using
the online platform, thus providing no meditation data. Analyses
are based on the following groups: TC1 78 participants, 58 %
female, mean age 41.4 (minimum age = 20, maximum age = 55);
TC2 78 participants, 59 % female, mean age 41.3 (minimum
age = 21, maximum age = 55); and TC3 73 participants, 60 %
female, mean age 40.7 (minimum age = 21, maximum age = 55).
Additionally, by the start of the second module (affect for TC1,
perspective for TC2), one participant provided no meditation
data in TC1 and three provided no meditation data in of TC2.
By the start of the third module (perspective for TC1, affect for
TC2), four additional participants ceased to provide meditation
data in TC1 and two participants ceased to provide meditation
data in TC2. The total participant-level meditation data loss rate
by the last module completed was thus 8.75 % for TC1, 10 % for
TC2,and10%forTC3.
Procedure
Four different meditation practices were taught as part of the
ReSource Project, a module-based 9-month secularized mental
training program (Singer et al. 2016). The practices, different in
content and goals, are matched in training context (e.g., length of
retreats, amount of practice each week, length and structure of
weekly group sessions, and a shared pool of teacher practi-
tioners). As with most recent meditation research performed in
the West, the training has been secularized. The first module,
called presence, teaches two core practices; Bbreathing
meditation^and Bbody scan^cultivate attention and interoceptive
awareness. The second module, called affect, teaches Bloving-
kindness^meditation, with the purpose of creating positive,
other-focused mental states and prosocial motivation. The third
module, called perspective, teaches Bobserving-thought^medita-
tion, in order to learn to identify and detach from the contents of
thought and decrease reactivity to mental events. The affect and
perspective modules also include near-daily dyadic meditations,
the effects of which are discussed elsewhere (Kok and Singer,
Contemplating the Other: Introducing the Contemplative Dyad
and its effects on social closeness, motivation and personal dis-
closure over six months of mental training via a randomized
clinical trial, under review). Participants underwent the same
number of hours in retreats and teacher-led meditation training
for all three modules. Teaching was conducted in teams to avoid
confounding content with a particular teacher, although it was not
possible to fully counterbalance teachers across practices to
completely eliminate the potential effects of particularly effective
teachers (Ospina et al. 2007). Each of the three modules of the
ReSource Project serves as an active control for the other mod-
ules, allowing the assessment of practice-specific effects.
To explore sequence effects on training and create active
control groups, participants were divided into three training
cohorts, each of which experienced the modules in a different
order. Training cohorts 1 and 2 began the study with a 3-day
retreat led by experienced meditation teachers, where they
started training breathing meditation and body scan (details
about the retreats and content of the training program have
220 Mindfulness (2017) 8:218231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
been published in Singer et al. 2016). At the retreat, partici-
pants were also introduced to the ReSource data collection
website, including guided meditation recordings and a series
of online questions to be answered before and after meditat-
ing. For the next 13 weeks, participants were asked to practice
breathing meditation for a minimum of 5 days a week and to
conduct a body scan for a minimum of 5 days a week, using
the guided meditation recordings and completing the pre-
meditation and post-meditation questions before and after
each practice. Guided meditations were available in 20-min
(body scan) and 10-min (breathing meditation) lengths. In
addition, participants attended weekly 2-h sessions with med-
itation teachers from the retreat.
After 13 weeks of presence training (see also Fig. 1), par-
ticipants in TC1 began 13 weeks of affect training in loving-
kindness meditation and an emotion-focused dyadic exercise,
starting with a 3-day retreat. Participants in TC2 began
13 weeks of perspective training in observing-thought medi-
tation and a perspective-taking dyadic exercise, also starting
with a 3-day retreat. For reasons of different format and con-
tent, the effects of the dyadic exercises will not be addressed
here. As before, participants were asked to practice their core
meditation (loving-kindness meditation for TC1 and
observing-thought meditation for TC2) at least 5 days a week
(in addition to a 2-h teacher-led group session each week),
using guided meditation recordings available on the study
website, and to complete the online questionnaire before and
after practice. Participants also continued to attend their 2-h
long weekly training sessions with meditation teachers, focus-
ing on the new practice.
After the second 13-week training module was completed,
participants in TC1 were assigned to the perspective module
and participants in TC2 were assigned to the affect module,
following the same pattern of retreat, meditation and dyadic
activities, daily training and assessment, and weekly meetings
described previously (see Fig. 1). Aside from the
counterbalanced order of the affect and perspective modules
and inevitable variations in season due to the staggered start
times of the two training cohorts, participantsexperiences
were intended to be identical across TC1 and TC2; all partic-
ipants in both cohorts experienced the exact same combina-
tion of the same meditation practices taught by the same group
of teachers, listened to the same text recorded on the medita-
tion platform, and answered the same questions before and
after daily practice.
Training cohort 3 attended a 3-day retreat structured
similarly to the affect retreat for TC1 and TC2, where
they were introduced to all core exercises of the affect
module including loving-kindness meditation, and to the
ReSource data collection website. Their practice expecta-
tions and assessment schedule were identical to TC1 and
TC2, with the exception that they only practiced for one
13-week period.
At the end of the final 13-week period, training and assess-
ment ended for all participants in all cohorts, although partic-
ipants were still able to use the online meditation recordings
and complete the questionnaires if they wished. Follow-up
assessments were completed 4 and 10 months after the end
of training. The results of those assessments will not be
discussed here.
Measures
The ReSource Project involved a wide range of assessments,
with a full list available in Singer et al. (2016). Here, we
analyze changes measured by a battery of quantitative pre-
meditation and post-meditation questions.
In order to reduce demands on the participantstime, ques-
tions were divided into four blocks, with two question blocks
administered each day (see Fig. 1; note that the Bopen
response^free-writing block is not shown in the figure).
One block of questions (Bfeeling states^) was administered
every day, while the others were presented in counterbalanced
order across the weeks. The same question was asked before
the meditation began and after it ended. Unless otherwise
noted, answers were given using a continuous slider ranging
from 0 (Bnot at all^)to19(Bvery much^).
The first question group was comprised of eight items, the
six questions of the cube of thought, which assess the contents
of thought, and two questions concerning attitude toward
thoughts (Ruby et al. 2013). Participants indicated the extent
that their thoughts were about the future, the past, the self, and
others and how positive and negative these thoughts were.
Participants then reported how much they had judged the
thoughts (considering some thoughts good and some bad,
for example) and how sure they were that they had accurate-
ly reported the content of their thoughts. These final two
questions (Bjudging thoughts^and Bsureness^)werenotan-
alyzed due to participant reports that those questions were
difficult to understand. The pre-meditation questions con-
cerned thoughts from the 30 min previous to answering the
questions. The post-meditation questions concerned thoughts
during the meditation.
The second question block assessed meta-cognition.
Participants indicated the extent that in the 30 min before
meditating (pre) and during the meditation (post), they felt
Bdistracted by thoughts,^Boccupied by thoughts,^and that
their mind was Bbusy^with thoughts. Participants also indi-
cated how aware they were of having thoughts and how aware
they felt of the contents of their thoughts. The three questions
concerning distraction (distracted, occupied, busy) were aver-
aged to create a Bthought distraction^score (mean daily α=
0.87, SD = 0.03). The two questions concerning thought
awareness and thought content were averaged to create a
Bthought awareness^score (mean daily α=0.77,SD =0.06).
Mindfulness (2017) 8:218231 221
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
The third question block was comprised of 2 min of free-
writing before and after the meditation, where participants
were asked to record their thoughts and feelings as they oc-
curred during the 2-min period. Analyses of these data are not
yet complete.
The questions that were asked every day assessed affect,
present-focused awareness, and interoception. They included
an affect grid where participants reported valence and arousal
just before and just after meditating, using a scale from 0 to 8
for each dimension (Russell et al. 1989). Participants also
reported how warm they felt, how present they felt, and how
aware of their body they felt.
In total, participants who followed the instructions to prac-
tice the core meditations 5 days a week would have completed
each of the three question groups 20 times per 3-month period
and completed the fourth daily group 60 times per 3-month
period. Ultimately, we recorded approximately 66,390 mea-
surement points representing over 11,000 h of meditation.
Data Analyses
To test for within-person training effects, a three-level hierar-
chical linear model was fitted using the nlme package in R for
each variable. Data was structured into measurement days
(level 1), nested within practices (level 2), and nested within
persons (level 3); comparisons between practices occur at lev-
el 2 and are within-person. Daily measurements were provid-
ed in groups of two, one before the meditation and one after-
ward. Tests of random effects (available in the online
Supplementary material) revealed that, for all variables in
TC1 and TC2, a three-level model was a better fit to the data
than either a simple linear model or a two-level hierarchical
linear model.
Each model included predictors representing type of med-
itation practice (practice, a categorical variable with four
levels), whether the measurement took place before or after
practice (post), and their interaction. State effects of practice
Fig. 1 Study design, timeline, and day-to-day meditation measures. A
fourth question block requesting that participants free-write about their
mental state was also included in the design but is not discussed here.
Section Aadapted with permission from Singer et al. (2016), p. 36,
Figure 4.1, with the timelines for control groups and long-term follow-
ups removed
222 Mindfulness (2017) 8:218231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
were not moderated by a linear effect for the passage of time,
and thus, the interactions of time with post and practice are not
included in the final models described here; tests of the effect
of time on the magnitude of state change are available in the
Supplemental material. Details concerning the selection and
coding of person-level and day-level covariates (including
time), selection of random effects, contrast coding, the final
model equations, and other model-specific information are
available in the Supplementary material.
To test for between-person sequence effects, we fitted a
two-level hierarchical linear model with time nested with-
in participant for each variable. Each model included pre-
dictors representing training cohort (training cohort,a
categorical variable with three levels), whether the mea-
surement took place after practice (post), and their inter-
action. Details concerning the selection and coding of
person-level and day-level covariates (including time), se-
lection of random effects, contrast coding, the final model
equations, and other model-specific information are avail-
able in the Supplementary material.
To explore potential changes in intervariate relationships,
we utilized network analysis, a technique for graphically ex-
ploring relationships between multiple variables (Borsboom
and Cramer 2013). Additional details are provided in the
Supplementary material.
Results
Compliance
Participants were asked to practice the core meditation(s) of
the current module at least five times per week, in addition to
the weekly training session. Mean weekly meditation frequen-
cies are shown in Table 1. For a detailed multilevel analysis of
compliance rates by group and practice type over time, see
section 10.2 of Singer et al. (2016). In general, compliance
rates were higher for the presence module than for the other
two modules.
Within-Person Analyses
Tab le 2provides the pvalues for the omnibus Ftests,
change estimates for each practice, and the contrasts
among the practices as appropriate. Individual practice
changes are also shown in Fig. 2. Information on the
degrees of freedom, Fvalues, and significance tests for
all predictors are included in the Supplemental material.
Models were also run without covariates (age, gender,
media, time, weekend, Christmas), and the results showed
a highly similar pattern of significance. These analyses are
also included in the Supplemental material.
The presence of two cohorts undergoing the same training
program at different times means that TC2 can be interpreted
as a replication of TC1. In light of this, correction for multiple
testing was not used, but only statistically significant changes
and practice differences that are shared across both cohorts
will be interpreted.
While practicing breathing meditation did significantly in-
crease present focus, this change was not greater than for the
other three meditation types. Body awareness also increased
significantly after breathing meditation practice but no more
so than after loving-kindness meditation and observing-
thought meditation and less than after bodyscan. Finally, there
was a statistically significant decrease in the amount of
thoughts encompassing three of the six descriptors of thought
content (future, others, negative), and no significant increases
in the amount of thought types for the other three thought
content descriptors, indicating an overall decrease in thought
quantity during breath-focused meditation.
As shown in Fig. 3, the phenomenological space for
breathing meditation was defined by two clusters, one
comprised of meta-cognition, interoceptive awareness,
and present-moment focus and the other linking thoughts
of others to future-oriented, non-self-focused thoughts.
Body scan showed the highest increase in body awareness
of all practices studied; present focus also increased but no
more than for other practices. Body scan was also associated
with a statistically significant decrease in the amount of
thoughts encompassing four of the six descriptors of thought
content (future, past, others, negative), and no significant in-
creases in the amount of thoughts for the other two descriptors
of thought content, indicating an overall decrease in thought
quantity during body scan meditation.
Consistent with similarities in training and goals for the
two practices, the phenomenological space for body scan
is very similar to that of breathing meditation, two clus-
ters, one characterized by links between present focus,
body awareness, thought awareness, and distraction by
thoughts and one representing the structure of non-task-
related thought (mind-wandering).
As anticipated, during loving-kindness meditation, partici-
pants reported the greatest increase in positively valenced
Tabl e 1 Number of meditation sessions per person per week
Meditation TC1 TC2 TC3
Mean SD Mean SD
Breathing 4.89 1.19 4.52 1.25
Body scan 4.38 1.20 4.34 1.24
Loving kindness 3.89 1.14 3.38 1.30 4.05 1.57
Observing thoughts 3.57 1.22 3.69 1.24
SD represents the between-person variance in mean compliance
Mindfulness (2017) 8:218231 223
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
thoughts and in fact, were the only group to show statistically
significant positive change in that variable. Regarding other-
focused thoughts, loving-kindness meditation again had the
greatest increase in other-focused thoughts relative to the other
groups, but this positive change was only significant for TC2.
In TC1, this difference was mainly due to large decreases in
other-focused thought in breathing meditation and body scan.
Contrary to our hypothesis, while loving-kindness meditation
was related to increases in subjective warmth, these changes
were no greater than the warmth changes that occurred during
the breathing and observing-thought meditations, although
they were higher than the change that occurred in body scan.
Finally, all four practices demonstrated statistically significant
increases in positivity of affect, but the increase associated
with loving-kindness meditation was not reliably larger than
in the other practices as had been hypothesized.
In loving-kindness meditation, changes in the phenomeno-
logical space are divided into three clusters. Awareness of
thoughts and thought distraction are now distinct from aware-
ness of the body and the present moment, the latter now
linking to feelings of warmth. Finally, the thought content
cluster is consistent with the goal of loving-kindness
Tabl e 2 Hierarchical linear model-derived state change estimates by training cohort
Characteristic Training cohort 1 Training cohort 2
Breathing Body
scan
Loving
kindness
Observing
thoughts
pvalue Breathing Body
scan
Loving
kindness
Observing
thoughts
pvalue
Future 1.20
a
2.32 1.44
a
0.18 0 1.49
a
2.46
b
2.00
ab
0.28 0
Past 0.43 0.90
a
0.85
a
0.66 00.20 0.81
a
0.76
a
0.45 0
Self 0.09
a
0.16
a
0.05
a
0.16
a
0.66 0.00
a
0.13
a
0.42
a
0.17
a
0.48
Others 1.76 2.90 0.29 0.34 0 1.96 2.64 0.65 0.45 0
Positive 0.44
a
0.56
a
0.58 0.20
a
00.23
a
0.10
a
1.03 0.06
a
0
Negative 0.76 1.16
a
1.28
a
0.34 00.64 1.12 1.57 0.25 0
Affect 0.44
a
0.51
a
0.39
a
0.30 00.50
a
0.65 0.51
a
0.52
a
0
Energy 0.36
a
0.77 0.42
a
0.45
a
00.53
a
0.74
b
0.56
ac
0.67
bc
0.01
War m th 0.56
ab
0.34
a
0.65
b
0.48
ab
00.51
a
0.29
b
0.59
a
0.42
ab
0
Present 1.74
a
1.79
a
1.57
a
1.62
a
0.4 1.71
a
1.94
a
1.74
a
1.85
a
0.43
Body aware 1.49
a
2.34 1.37
a
1.68
a
01.42
a
2.34 1.47
a
1.70
a
0
Distraction 1.08
a
2.00 1.46
b
1.29
ab
01.42
a
1.88
b
1.64
ab
1.57
ab
0.06
Thought
aware
0.79
a
0.17 0.44
a
1.47 00.56
a
0.01 0.71
a
1.25 0
Change estimates significantly different from zero (p<0.05) are indicated in ital. For each row within each training cohort, values sharing a superscript
are not significantly different from one another (p0.05)
Fig. 2 Estimates and 95 %
confidence intervals for model-
derived state changes in the four
mental training practices of
training cohorts 1 and 2
224 Mindfulness (2017) 8:218231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
meditation linking positive thoughts to self- and other-
oriented thoughts and negatively to a cluster of negatively
valenced, past-related thoughts.
As anticipated, observing-thought meditation led to the
largest statistically significant increase in thought aware-
ness of all four practices. Observing thoughts also signif-
icantly decreased distraction by thoughts; however, this
change was not statistically different from the change in
thought distraction caused by breathing meditation or
loving-kindness meditation. In TC1, body scan practice
causedparticipantstobeevenlessdistractedbythoughts
than observing-thought meditation.
Observing thoughts led to four small, narrowly defined
clusters. One cluster now relates affect and energy; the second
past-negative thoughts; the third future-other related thoughts;
and the last, similar to loving-kindness meditation, links body
awareness, present focus, and warmth.
All four practices showed significant increases in posi-
tivity of affect, present focus, ability to avoid being distract-
ed by thoughts, energy, and body awareness. BSelflessness^
is an additional pursuit often associated with meditation.
However, in both TC1 and TC2, there was no significant
change in the amount of self-related thoughts for any of the
four practices.
Between-Person Analyses
Figure 4shows the differences between the training cohorts in
the effects of loving-kindness meditation, reflecting a signifi-
cant effect for interaction of group and practice. Information
on the significance tests for all coefficients is included in the
Supplemental material. Models were also run without covar-
iates (age,gender,media,time,weekend), and the results
showed a highly similar pattern of significance. These analy-
ses are also included in the Supplemental material.
For the majority of variables, there was no difference be-
tween groups in the amount of change occurring due to
loving-kindness meditation. Critically, even in the absence
of 3 months of attention training, loving-kindness meditation
still increased present focus, body awareness, thought aware-
ness, and ability to disengage from distracting thoughts just as
much as in other training cohorts, despite the fact that these
changes are more closely associated with presence training
than with loving-kindness meditation.
Fig. 3 Partial correlation
structures for each mental training
practice combined across TC1
and TC2. Amount of change is
represented by relative circle size
and corresponds to the estimates
in Table 2. Paths between circles
represent the significant partial
correlations, with solid lines
representing positive and
dashed lines representing
negative correlations. Variables
without significant correlations
are not shown
Mindfulness (2017) 8:218231 225
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Some unanticipated differences between cohorts did ap-
pear. Participants who did not receive preparatory presence
training, but did the affect module immediately, showed a
significantly smaller decrease in negative thoughts during
meditation compared to the other groups. These participants
also showed the highest increase in positivity of affect and the
greatest increase in subjective warmth.
The pattern of intervariate relationships for loving-
kindness meditation without the presence module (shown in
Fig. 5) differed somewhat from the pattern for loving-
kindness meditation with presence training. While thoughts
of others were still associated with positively valenced
thoughts and decreased negatively valenced thoughts, the re-
lationship between thought awareness and present-focus was
different. In the original two cohorts, there was no link
between thought awareness and present focus in loving-
kindness meditation, although they were positively linked
in body scan and breathing meditations. Here, they are
negatively linked through changes in energy, suggesting that
in the absence of presence training, participants found it diffi-
cult to sustain awareness of their thoughts and the present
moment simultaneously.
Discussion
The purpose of the present work was to compare the differen-
tial psychological effects of daily practice of four different
types of meditation included in the Resource Project, a 9-
month long longitudinal study of mental training (Singer
et al. 2016). We specifically focused on identifying patterns
of training-related change in experienced affect, thought con-
tent, meta-cognition, and body awareness. Training consisted
of three 13-week modules (presence, affect, perspective), each
comprised of two core practices that targeted attentional,
socio-affective, and socio-cognitive functions, respectively.
Two of the core practices were dyadic in nature, and their
effects will be discussed elsewhere. The other four were
Fig. 4 Model-derived state
change estimates for loving-
kindness meditation for training
cohorts 1, 2, and 3. The error bars
represent the person-level
standard errors. The stars
represent change significantly
different from zero
226 Mindfulness (2017) 8:218231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
single-person meditations, breathing meditation and body
scan (presence), loving-kindness meditation (affect), and
observing-thought meditation (perspective). Training modules
were matched in the time required, the learning environment,
the structure and length of retreats, the frequency of practice,
the availability of support through the online platform and a
smartphone app, and teacher investment. We expected differ-
ential effects of these types of mental practices on subjective
outcome measures assessed before and after daily practice of a
given meditation.
As hypothesized, each of the four mental practices showed
unique Bmental fingerprints^of change. These fingerprints
were expressed as differential training-related effects on self-
reported measures of affect, cognition, and body and meta-
cognitive awareness, as well as differences in the structure
of the relationships among variables as illustrated by the net-
work analyses.
Specifically, breathing meditation, trained during the pres-
ence module, decreased the overall number of thoughts and
the tendency to be distracted by thoughts and increased pres-
ent focus, interoceptive awareness, positivity of affect,
warmth, and energy. The fingerprint of body scan, also trained
during the presence module, was similar to that of breathing
meditation. Participants decreased in overall number of
thoughts and the tendency to be distracted by thoughts and
increased present focus, positivity of affect, and energy. Body
scan led to the highest increase in body awareness of all four
practices. Network analyses of breathing meditation and body
scan revealed two main clusters, the first linking awareness of
thought and distraction by thoughts to body awareness and
present focus and the second linking increased thoughts about
others and thoughts about the future to decreased thoughts
about the self. This suggests that participants may have used
body focus and present-moment focus asa way of coping with
distraction by thoughts. Such a strategy is congruent with the
training goal to increase awareness of all present-moment ex-
perience, including bodily sensations and thoughts. The sec-
ond cluster could be interpreted as Bmind-wandering,^as at-
tention is diverted from the self (and the breathing or bodily
sensations that are the target of the meditations) toward others
and potential future or past events.
Loving-kindness meditation led to expected increases
in positively valenced thoughts, a change not observed for
the other three practices. Other-focused thoughts also in-
creased relative to the other practices, but only training
cohort 1 showed a statistically significant absolute in-
crease in other-focused thought. Feelings of subjective
warmth and positivity of affect also increased but no more
than for the other practices. As with all other practices,
participants also increased present focus, interoceptive
awareness, and energy. This mental pattern maintained
both for loving-kindness meditation learned in sequence
with other modules and loving-kindness meditation taught
without other modules. Loving-kindness meditation without
other modules, however, was more effective at enhancing
warmth and positivity of affect.
Follow-up network analyses further differentiated loving-
kindness meditation from other practices. Changes in meta-
cognition were uncoupled from changes in interoceptive
awareness and present focus, suggesting a shift from cultivat-
ing general attention to domain-specific attention.
Furthermore, body awareness and present focus were not only
positively related to each other but also to warmth. Finally,
positively valenced thoughts were related to thinking about
self and others, and this thought pattern was negatively asso-
ciated with negatively valenced, past-focused thoughts. This
last Bthought cluster^is consistent with the instructions of
loving-kindness meditation to visualize loved others and ex-
tend good wishes of loving kindness and happiness to them
(Salzberg 1995). It further suggests that the more participants
think positive thoughts of self and others, the more ruminative
thoughts (negative and past-focused) are suppressed.
Interestingly, the uncoupling of meta-cognition and
interoception in loving-kindness meditation occurred only
when loving-kindness meditation was taught after the pres-
ence or perspective modules. When the affect module was
taught in isolation, meta-cognition and interoception were
positively associated, suggesting that this dissociation is not
inherent to loving-kindness meditation but may result from
approaching loving-kindness meditation with already
established meditation skills.
Fig. 5 Partial correlation structures for each TC3. Amount of change is
represented by relative circle size. Paths between circles represent the
significant partial correlations, with solid lines representing positive and
dashed lines representing negative correlations. Variables without
significant correlations are not shown
Mindfulness (2017) 8:218231 227
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Finally, observing-thought meditation, trained during the
perspective module, led as expected to the highest increase
in meta-cognitive awareness of thoughts. Participants were
also less distracted by thoughts but no more so than for other
practices. The goal of observing-thought meditation is to re-
fine the ability to categorize and observe thoughts without
reacting, as well as to cultivate awareness of the thought pro-
cess. This is manifest in the network analysis of many small,
separate clusters of conceptually linked variables, indicating a
nuanced approach to thoughts similar to what is trained in
MBCT (Fjorback et al. 2011; Strauss et al. 2014; Williams
et al. 2014). The cluster of affect and energy represent the
participants subjective state, while the past/negative cluster
may reflect a common ruminative pattern and the future/
other cluster has been linked to planning (Ruby et al. 2013).
The body awareness and present-focus cluster is also concep-
tually consistent, although the inclusion of warmth is unex-
pected. Finally, thought awareness and thought distraction are
uncoupled in observing-thought meditation, suggesting that
participants become more proficient in distinguishing between
meta-cognitive awareness of thoughts and being distracted by
thoughts. As for the other practices, participantsalso increased
in present focus, interoceptive awareness, positivity of affect,
warmth, and energy. Interestingly, no practice significantly
changed the amount of self-related thought experienced by
participants.
In summary, the following effects uniquely defined each of
the four core meditative practices: body scan led to the greatest
increase in interoceptive awareness, loving-kindness medita-
tion was best in increasing positively valenced and other-
focused thought and was the only practice to positively link
thoughts of self and others, and observing-thought meditation
was most effective in increasing meta-cognitive awareness of
thoughts and resulted in the highest number of distinguishable
thought-content clusters. There were no unique effects for
breathing meditation, which is used as a basic practice in
many contemplative traditions.
The fingerprints observed for the meditative practices, both
in individual variable changes and in distinct networks of relat-
ed intervariate change, provide validation for the idea that the
type of meditation matters. The choice of what type of medita-
tion to engage in, or what to focus on within a particular type of
meditation, has experiential consequences. Other studies have
shown that repeated subjective experiences such as anxiety
(Kubzansky et al. 2006) or positive affect (Fredrickson et al.
2008;Koketal.2013) can have significant and far-reaching
consequences for life, health, and longevity. In such a context,
meditation may prove a critical tool in helping to Bshift^the
tone of subjective experiences away from those known to be
noxious and toward more salubrious states.
Our findings have a number of every day and clinical im-
plications. By demonstrating distinct subjective Bfingerprints^
for four types of meditation taught in a shared context and
assessed using a shared question pool, we provide clear evi-
dence that some forms of meditation may be better suited to
certain professions or patient populations than others. The
fingerprints revealed here may help practitioners to choose a
meditative practice that is the best Bmatch^for the current
needs of their client. In addition, the overlapping effects
shared between practices also suggest that in some cases, the
choice of meditation can be guided by individual preference
without compromising the efficacy of the chosen practice.
Our findings also have implications for researchers who
may wish to study the effects of repeated subjective experi-
ences. Challenges in such research include attempting to
reliably and regularly induce the desired subjective experi-
ence and finding an effective matched control. Additional
analyses, reported in the Supplemental material, suggest
that the magnitude of change is relatively consistent over
time, indicating a lack of habituation. Furthermore, since
the state effects of breathing meditation appear to be a sub-
set of the effects found in the other three practices, pairing
breathing meditation with body scan, loving-kindness med-
itation, or observing-thought meditation would allow the
researcher to observe the long-term effects of repeatedly
experiencing interoceptive awareness, positive other focus,
or meta-cognitive awareness, respectively.
While practice-specific hypotheses were mostly confirmed
for breathing meditation, body scan, loving-kindness medita-
tion, and observing-thought meditation, there was also a sub-
stantial amount of un-hypothesized overlap between the dif-
ferent meditations. All practices left participants feeling hap-
pier, more energized, more present in the moment, more aware
of their bodies, and better able to disengage from distracting
thoughts.
Some of the shared or overlapping effects may be attributed
to continuing practice in directing, re-focusing, and sustaining
attention to a given object in the present moment, be it the
breath, parts of the body, a mental image, or a mental event
like a thought. Learning to focus attention and stay in the
present moment, detect when attention has wandered, and
return attention to the original target are fundamental to all
contemplative practices (Kabat-Zinn 1990), and a muscle is
exercised by all four mental training exercises studied here.
The analogy may be to a runner learning the geography of a
city; depending on where the runner goes, she will learn about
a different neighborhood, but no matter where she runs, her
muscular and cardiovascular system will show a similar pat-
tern of development over time. In the same way, different
meditative practices can simultaneously offer unique benefits
while sharing a common underlying pattern of gains.
Other effects, such as the improvements in mood and en-
ergy, could be due to the pleasant effects of learning a new
self-care skill. It could be also argued, since participants in
training cohorts 1 and 2 received breathing meditation and
body scan training before learning the other two practices, that
228 Mindfulness (2017) 8:218231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
these apparent Bcommonalities^might in actuality represent
carryover effects from the previous module. We were, how-
ever, able to investigate such sequence effects; TC1 and TC2,
where loving-kindness meditation was learned after the pres-
ence module, were compared to TC3, where loving-kindness
meditation was taught without any prior training. As described
above, we found few differences and many commonalities. In
particular, the increases in present focus, interoceptive aware-
ness, and energy, and decreases in distraction by thoughts, did
not differ significantly across the affect modules in TC1, TC2,
and TC3. This suggests that cultivating bodily awareness and
present focus is a core common feature of our four meditative
practices (or their context), as is feeling more positive and
energized after contemplative practice of any kind.
We have repeatedly referred to the richness of this data due
to the intensive measurement strategy of the project. While the
consistent and extensive measurement of participantssubjec-
tive states is a strength of this work, it retains the weaknesses
common to subjective self-report measures. The project was
designed to account for these weaknesses; asking participants
to report their mental state in the moment eliminates retrospec-
tive biasing of responses, and recording answers using sliding
scales rather than discrete values reduces the ability to repeat a
particular response from memory. However, self-report remains
only as valid as the participants own ability to introspect.
Collectingmanyrepeatedmeasurementsfromeachparticipant,
and using multilevel modeling to identify overall trends, helps
to separate the Bsignal^of real effects from the Bnoise^of error.
Similarly, the within-person nature of much of the ReSource
Project design is a strength that allows inferences about intra-
personal change due to meditation. However, within-person
designs are vulnerable to sequence effects. In the case of the
two main training cohorts (TC1 and TC2) of the ReSource
Project, the presence module was always taught first because
it laid the foundation for the other two modules, affect and
perspective. As practice compliance decreased over time, dif-
ferences between the presence practices and the other two core
practices (loving-kindness meditation in affect and observing-
thought meditation in perspective) could in part be attributed to
higher compliance rates in the presence module. Differences
between breathing meditation and body scan, however, would
not be affected by changes in compliance. Furthermore, the
counterbalanced training sequence for the affect and perspec-
tive modules across TC1 and TC2 controls for the potential
effects of compliance differences for those two modules.
Finally, participants in TC1 and TC2 underwent 9 months
of meditation training, a much longer period than is typical in
meditation research. A longer training period is useful for
observing whether the effectiveness of the various practices
changes over time. Training for three quarters of a year, how-
ever, means that the three modules were inevitably taught in
noticeably different seasons, with accompanying differences
in temperature, amount of sunlight, day length, etc. Seasonal
effects could be potentially confounded with differences in
training content. However, training in TC2 began 2 months
after TC1. In combination with the counterbalanced order of
the perspective and affect modules, the offset group design
ensures that none of the training modules were taught twice
in the same season. In addition, as shown in the Supplemental
material, there were no differences in the magnitude of state
changes for the two presence practices between TC1 and TC2,
despite being taught in different seasons. Thus, we conclude
that the effects of the training were not season-dependent.
Seasonal and compliance differences are confounding factors
in the between-person design used to investigate sequence effects
in the affect module across the three training cohorts. The affect
modules taught in TC1, TC2, and TC3 differ in sequence, sea-
son, and compliance rates. Thus, any differences between the
modules could potentially be due, in whole or in part, to non-
training-related differences. It is all the more surprising, therefore,
that almost no group differences were found; the affect module
training thus appears to be robust against variation in seasons and
compliance rates as observed in this study.
In conclusion, the unique fingerprints associated with dif-
ferent types of contemplative mental training reveal that med-
itation is not about engaging in indiscriminate mental effort;
each practice appears to create a distinct mental environment,
the long-term consequences of which are only beginning to be
explored.
Acknowledgments Open access funding provided by Max Planck
Society. We are thankful to all the members of the Department of Social
Neuroscience involved in the ReSource study over the years,in particular
to all ReSource teachers that taught the intervention program, to Astrid
Ackermann, Christina Bochow, Matthias Bolz, and Sandra Zurborg for
managing the large-scale longitudinal study; to Hannes Niederhausen,
Henrik Grunert, and Torsten Kästner for their technical support; and to
Sylvia Tydeks, Elisabeth Murzick, Manuela Hofmann, Sylvie Neubert,
and Nicole Pampus for their help with recruitment and data collection.
Compliance with Ethical Standards
Funding Tania Singer, as principal investigator, received funding for
the ReSource Project from (a) the European Research Council under the
European Communitys Seventh Framework Program (FP7/20072013/
ERC Grant Agreement Number 205557 to T.S.) and (b) from the Max
Planck Society.
Conflict of Interest The authors declare that they have no conflict
of interest.
Open Access This article is distributed under the terms of the Creative
Commons Attribution 4.0 International License (http://
creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided you give
appropriate credit to the original author(s) and the source, provide a link
to the Creative Commons license, and indicate if changes were made.
Mindfulness (2017) 8:218231 229
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
References
Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integra-
tive approach to the structure of psychopathology. Annual Review of
Clinical Psychology, 9(9), 91121. doi:10.1146/annurev-clinpsy-
050212-185608.
Carter, O. L., Presti, D. E., Callistemon, C., Ungerer, Y., Liu, G. B., &
Pettigrew, J. D. (2005). Meditation alters perceptual rivalry in
Tibetan Buddhist monks. Current Biology, 15(11), R412R413.
doi:10.1016/j.cub.2005.05.043.
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.
Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological
and clinical features of mindfulness meditations. Psychological
Medicine, 40(8), 12391252. doi:10.1017/S0033291709991747.
Feldman, G., Greeson, J., & Senville, J. (2010). Differential effects of
mindful breathing, progressive muscle relaxation, and loving-
kindness meditation on decentering and negative reactions to
repetitive thoughts. Behaviour Research and Therapy, 48(10),
10021011. doi:10.1016/j.brat.2010.06.006.
Fjorback, L. O., & Walach, H. (2012). Meditation based therapiesa
systematic review and some critical observations. Religions, 3(1),
118. doi:10.3390/Rel3010001.
Fjorback, L. O., Arendt, M., Ornbol, E., Fink, P., & Walach, H. (2011).
Mindfulness-based stress reduction and mindfulness-based cogni-
tive therapya systematic review of randomized controlled trials.
Acta Psychiatrica Scandinavica, 124(2), 102119. doi:10.1111
/j.1600-0447.2011.01704.x.
Fredrickson, B. L., Cohn, M. A., Coffey, K. A., Pek, J., & Finkel, S. M.
(2008). Open hearts build lives: Positive emotions, induced through
loving-kindness meditation, build consequential personal resources.
Journal of Personality and Social Psychology, 95, 10451062.
doi:10.1037/a0013262.
Hart, W. (1987). The art of l iving: Vip assana-meditation as taught by S.N.
Goenka. San Francisco: Harper and Row.
Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., &
Schwartz, G. E. R. (2007). A randomized controlled trial of mind-
fulness meditation versus relaxation training: Effects on distress,
positive states of mind, rumination, and distraction. Annals of
Behavioral Medicine, 33(1), 1121. doi:10.1207/s15324796
abm3301_2.
Johnson, D. P., Penn, D. L., Fredrickson, B. L., Kring, A. M., Meyer, P.
S., Catalino, L. I., & Brantley, M. (2011). A pilot study of loving-
kindness meditation for the negative symptoms of schizophrenia.
Schizophrenia Research, 129(23), 137140. doi:10.1016/j.
schres.2011.02.015.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your
body and mind to face stress, pain, and illness.NewYork:Delacorte
Press.
Klimecki, O. M., Leiberg, S., Lamm, C., & Singer, T. (2013). Functional
neural plasticity and associated changes in positive affect after com-
passion training. Cerebral Cortex, 23(7), 15521561. doi:10.1093
/cercor/bhs142.
Klimecki, O. M., Leiberg, S.,Ricard, M., & Singer, T. (2014). Differential
pattern of functional brain plasticity after compassion and em-
pathy training. Social Cognitive and Affective Neuroscience,
9(6), 873879. doi:10.1093/Scan/Nst060.
Kok, B.E., Coffey, K.A., Cohn, M.A., Catalino, L.I., Vacharkulksemsuk,
T., Algoe, S., Fredrickson, B.L. (2013). How positive emotions
build physical health: perceived positive social connections account
for the upward spiral between positive emotions and vagal tone.
Psychological Science, 24(7), 112332. doi: 10.1177
/0956797612470827
Kubzansky, L.D., Cole, S.R., Kawachi, I., Vokonas, P., Sparrow,
D. (2006). Shared and unique contributions of anger, anxiety,
and depression to coronary heart disease: a prospective study
in the normative aging study. Annals of Behavioral Medicine,
31(1), 2129.
Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D.,
Byford, S. (2015). Effectiveness and cost-effectiveness of
mindfulness-based cognitive therapy compared with maintenance
antidepressant treatment in the prevention of depressive relapse or
recurrence (PREVENT): A randomised controlled trial. Lancet,
386(9988), 6373. doi:10.1016/S0140-6736(14)62222-4.
Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D.,
Good, R. C., & Essex, M. (2012). The theoretical and empirical
basis for meditation as an intervention for PTSD. Behavior
Modification, 36(6), 759786. doi:10.1177/0145445512441200.
Louchakova-Schwartz, O. (2013). Cognitive phenomenology in the
study of Tibetan meditation: phenomenological descriptions versus
meditation styles. Neurophenomenology and Its Applications to
Psychology,6187. doi: 10.1007/978-1-4614-7239-1_3
Lutz, A., & Thompson, E. (2003). Neurophenomenologyintegrat-
ing subjective experience and brain dynamics in the neurosci-
ence of consciousness. Journal of Consciousness Studies,
10(910), 3152.
Lutz, A., Slagter, H.A., Dunne, J.D., Davidson, R.J. (2008). Attention
regulation and monitoring in meditation. Trends in Cognitive
Sciences, 12(4), 163169.
MacCoon, D.G., Imel, Z.E., Rosenkranz, M.A., Sheftel, J.G., Weng,
H.Y., Sullivan, J.C., Lutz, A. (2012). The validation of an active
control intervention for Mindfulness Based Stress Reduction
(MBSR). Behaviour Research and Therapy, 50(1), 312.
doi:10.1016/j.brat.2011.10.011
Mirams,L.,Poliakoff,E.,Brown,R.J.,&Lloyd,D.M.(2013).
Brief body-scan meditation practice improves somatosensory
perceptual decision making. Consciousness and Cognition,
22,348359.
Obasi, C.N., Brown, R., Ewers, T., Barlow, S., Gassman, M., Zgierska,
A., Barrett, B. (2013). Advantage of meditation over exercise in
reducing cold and flu illness is related to improved function and
quality of life. Influenza and Other Respiratory Viruses, 7(6), 938
944. doi: 10.1111/Irv.12053
Olatunji, B. O., Naragon-Gainey, K., & Wolitzky-Taylor, K. B. (2013).
Specificity of rumination in anxiety and depression: A multimodal
meta-analysis. Clinical Psychology-Science and Practice, 20(3),
225257. doi:10.1111/Cpsp.12037.
Ospina, M.B., Bond, T.K., Karkhaneh, M., Tjosvold, L., Vandermeer, B.,
Liang, Y., Klassen, T.P. (2007). Meditation practices for health:
State of the research. Evidence report/technology assessment No.
155. Rockville, MD
Ospina, M.B., Bond, K., Karkhaneh, M., Buscemi, N., Dryden, D.M.,
Barnes, V., Shannahoff-Khalsa, D. (2008). Clinical trials of med-
itation practices in health care: Characteristics and quality. Journal
of Alternative and Complementary Medicine, 14(10), 11991213.
doi:10.1089/acm.2008.0307
Ruby, F.J.M., Smallwood, J., Engen, H., Singer, T. (2013). How self-
generated thought shapes moodthe relation between mind-
wandering and mood depends on the socio-temporal content of
thoughts. PLoS One, 8(10). doi: 10.1371/journal.pone.0077554
Russell, J. A., Weiss, A., & Mendelsohn, G. A. (1989). Affect grida
single-item scale of pleasure and arousal. Journal of Personality and
Social Psychology, 57(3), 493502. doi:10.1037/0022-
3514.57.3.493.
Sakyong, M. (2003). Turning the mind into an ally. New York: Riverhead
Books.
Salzberg, S. (1995). Loving kindness: The revolutionary art of happiness.
Boston: Shambhala Publications.
230 Mindfulness (2017) 8:218231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Salzberg, S. (2005). The force of kindness: Change your life with love and
compassion. Louisville: Sounds True, Inc.
Sauer-Zavala, S. E., Walsh, E. C., Eisenlohr-Moul, T. A., & Lykins,
E. L. B. (2013). Comparing mindfulness-based intervention
strategies: Differential effects of sitting meditation, body scan,
and mindful yoga. Mindfulness, 4(4), 383388. doi:10.1007
/s12671-012-0139-9.
Singer, T., & Klimecki, O.M. (2014). Empathy and compassion. Current
Biology, 24(18), R875-R878. Retrieved from <Go to ISI>://WOS:
000342396900018
Singer, T., Kok, B.E., Bornemann, B., Zuborg, S., Bolz, M., Bochow,
C.A. (2016). The ReSource project: Background, design, samples,
and measurements (2nd ed.). Leipzig, Germany: Max Planck
Institute for Human Cognitive and Brain Sciences.
Strauss, C., Cavanagh, K., Oliver, A., Pettman, D. (2014). Mindfulness-
based interventions for people diagnosed with a current episode of
an anxiety or depressive disorder: a meta-analysis of randomised
controlled trials. PLoS One, 9(4). doi: 10.1371/journal.
pone.0096110
Williams, J.M.G., Crane, C., Barnhofer, T., Brennan, K., Duggan, D.S.,
Fennell, M.J.V., Russell, I.T. (2014). Mindfulness-based cogni-
tive therapy for preventing relapse in recurrent depression: A ran-
domized dismantling trial. Journal of Consulting and Clinical
Psychology, 82(2), 275286. doi: 10.1037/A0035036
Mindfulness (2017) 8:218231 231
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
... This proposition has been confirmed by recent work [5,[26][27][28]. For example, in a large-scale 9-month study, the ReSource project [29] employing three distinct intervention modules, it was shown that attention-focused mindfulness practices led to enhanced interoceptive awareness and attention control [30,31], socio-cognitive perspective-taking practices led to improvements in meta-cognitive awareness and Theory of Mind [30,31], and socio-affective practices led to increases in compassion and prosocial behavior and reductions in social stress [31][32][33]. ...
... This proposition has been confirmed by recent work [5,[26][27][28]. For example, in a large-scale 9-month study, the ReSource project [29] employing three distinct intervention modules, it was shown that attention-focused mindfulness practices led to enhanced interoceptive awareness and attention control [30,31], socio-cognitive perspective-taking practices led to improvements in meta-cognitive awareness and Theory of Mind [30,31], and socio-affective practices led to increases in compassion and prosocial behavior and reductions in social stress [31][32][33]. ...
... However, only MB intervention led to significant temporal reductions in worry, which involves perseverative thinking about future threats [95,96]. Previous studies have shown the effectiveness of MBIs in reducing perseverative thinking [54,97], and prior studies [30,98] have demonstrated that attention-focused meditation reduces past-and future-related thoughts while socio-emotional practices increase positive other-related thoughts. Our findings extend this prior work by showing that different practices lead to temporal reductions in specific components of perseverative thinking. ...
Article
Full-text available
Background: App-based contemplative interventions, such as mindfulness-based interventions, have gained popularity for the promotion of mental health; however, the understanding of underlying intervention-specific mechanisms remains limited, especially related to novel inter-relational dyadic practices. Methods: We tested (n = 253) seven putative mechanisms underlying two brief (daily 12-min) online mental interventions: attention-focused mindfulness and socio-emotional partner-based, both supported by weekly online coaching. Weekly self-reports of rumination, worry, psychological flexibility, affective control, social support, acceptance, and mindfulness were obtained over 10 weeks of intervention, and depression, anxiety, and resilience were assessed as pre- and post-intervention outcomes. Results: Significant week-to-week reductions in rumination and increases in psychological flexibility were observed in both interventions. Only attention-based practice led to temporal reductions in worry, and only socio-emotional dyadic practice led to temporal increases in affective control. Mediation analyses with slopes of weekly variables as mediators detected no significant indirect effects. However, exploratory moderation analyses revealed that intervention-related reductions in depressive symptomatology and anxiety vulnerability and increases in resilience were predicted by weekly increases in acceptance and affective control in the socio-emotional dyadic group, and by weekly reductions in rumination and worry in the mindfulness group. Limitations of the study include reliance on brief self-report measures, relatively small sample size, and absence of long-term follow-up assessments indicating the need for future well-powered longitudinal studies comparing intervention modalities. Conclusions: We present preliminary evidence for practice-specific active ingredients of contemplative interventions, which can be leveraged to enhance their efficiency for mental health.
... Therefore, the main goal of the present study was to investigate whether shorter, purely online mental training formats based on specific types of daily practices, such as attention-focused mindfulness or partner-based socio-emotional exercises, supported by online coaching sessions, could still result in reliable effects for mental health and resilience. More specifically, we compared two online interventions, one consisting of 12-min daily attention-based solitary mindfulness practice and the other of a 12-min daily socio-emotional dyadic practice (Kok and Singer, 2017b) over 10 weeks, both supported by weekly online coaching sessions with experts to deepen the practice. ...
... In the socio-emotional training, the primary exercise was the daily practice of 12-min Affect Dyad (Kok and Singer, 2017b) which took place with a random app-assigned weekly partner. In this exercise, the two partners took turns describing first a situation in the past day in which they experienced difficult emotions and their experience in the body and then a gratitude-eliciting situation and how gratitude felt in their body. ...
... Importantly, these reductions in negative (and by-default increases in positive) interpretation bias mediated trainingrelated changes in depression and trait anxiety in the socio-emotional intervention. The key ingredients of the core practice of socioemotional intervention (Affect Dyad), such as acceptance of difficult emotions, tolerance of change, and cultivation of gratitude (Hildebrandt et al., 2019;Hildebrandt et al., 2017;Kok and Singer, 2017b;Kok and Singer, 2017a), all of which also reflect in increased CD-RISC scores, could be associated with reductions in negative information processing and seeing the world with more positive and non-judgmental eyes, which is a goal of contemplative practices (Kabat-Zinn, 2003). This more positive interpretation of the world then further leads to reduced psychopathological outcomes and a more resilient response to stress. ...
... Various forms of meditation can be broadly defined as practices of paying attention to present moment percepts in a sustained way and without judgement [14,15]. The TM approach is based on a silent repetition of a personalized mantra [16] and is taught by certified teachers during a standardized four-day induction process. ...
Article
Full-text available
A set of interventions that can produce altered states of consciousness (ASC) have shown utility in the treatment of substance misuse. In this review, we examine addiction-related outcomes associated with three common interventions that produce ASCs: psychedelic-assisted psychotherapy (PP), Transcendental Meditation (TM) and hypnotherapy (HT). While procedurally distinct, all three interventions are associated with some common phenomenological, psychological, and neurobiological features, indicating some possible convergent mechanisms of action. Along with addiction and mental health outcomes, these common features are reviewed, and their impact on substance misuse is discussed. While our review highlights some mixed findings and methodological issues, results indicate that PP and TM are associated with significant improvements in substance misuse, alongside improvements in emotional, cognitive and social functioning, behavior-change motivation, sense of self-identity, and meaning. In contrast, and despite its broader acceptance, HT has been associated with mixed and minimal results with respect to substance misuse treatment. Authors identify key research gaps in the role of ASC interventions in addiction and outline a set of promising future research directions.
... The ReSource project, a large 9-month trial consisting of three 3-month modules, compared the effects of different types of meditation on a range of variables (Singer & Engert, 2019). They observed similar differences in the subjective experience of breathing meditation, the body scan, lovingkindness meditation, and observing-thoughts meditation with respect to daily experience (Kok & Singer, 2017), perceived effort and likability (Lumma et al., 2015), and descriptions in micro-phenomenological interviews (Przyrembel & Singer, 2018). Breathing meditation and the body scan reliably increased interoceptive awareness (Bornemann et al., 2015). ...
Article
Full-text available
Meditation encompasses a variety of techniques, but little is known on how and for whom they work. This study explored potential mechanisms of four different meditation techniques in beginners and which technique might be suited for whom. Using an experimental single-case design, we compared the longitudinal effects of concentrative, humming, observing-thoughts, and walking meditation. Forty-four healthy participants without meditation experience were randomly assigned to one of the four techniques and 42 completed the treatment. Following a baseline period of 2 to 4 weeks, participants learned and practiced their technique 20 min daily for 6 to 8 weeks and completed daily online questionnaires throughout the entire study period. At pretest, we assessed participants’ motivation and personality. We analyzed the data visually and by conducting single-case meta-analyses, correlation, and multivariate analyses. Body awareness, decentering, and emotion regulation improved reliably and continuously over time, for all four techniques. Thus, these processes could represent common mechanisms for novice meditators. Walking meditation led to the smallest improvements in decentering and mind-wandering, but the highest in body awareness and emotion regulation. Individuals varied in response to the treatment. The two “classic” techniques (concentration, observing-thoughts) led to more consistently positive multivariate response patterns and to better responses in participants high in neuroticism. In contrast, those high in extraversion benefitted more from the two unusual ones (humming, walking). We additionally observed interesting interactions with different motivational reasons. With this study, we hope to contribute to theory building and answering two urgent questions—what the key mechanisms of meditation are and who benefits most from what kind of practice.
... Both interpretations suggest DMN suppression. Since Ng et al. (2021) did not observe the same gamma suppressing effect when contrasting resting state with breathing awareness, we hypothesize our effects may result from MBSR body scan practices, which have been shown to elicit stronger responses than breath awareness practices (Kok & Singer, 2017). Additionally, these differences may arise from different populations-neurotypicals versus adults with ASD. ...
Article
Full-text available
Objectives Mindfulness-based therapies can reduce depression and anxiety in adults with autism spectrum disorder (ASD). However, the underlying neurophysiological mechanisms have yet to be fully characterized. While mindfulness-related improvements are theorized to be derived from alterations to resting-state networks—especially within the default mode network (DMN)—in other clinical populations, it is unclear if changes in DMN neurophysiology relate to symptom reduction in autistic adults.Method In this randomized controlled trial, 96 adults with ASD were assigned to either a Mindfulness-Based Stress Reduction (MBSR) or a social support and relaxation education (SE) active control group. Resting-state electroencephalography recordings and self-report questionnaires assessing depression (BDI-2) and trait anxiety (STAI-2) were collected before and after the 8-week intervention to examine neurophysiological correlates of DMN activity—namely, gamma and high beta (beta-2) power across midline electrodes.ResultsSpectral power analysis of neurophysiological signatures of DMN activity from 62 participants (MBSR n=29; SE n=33) identified distinct MBSR-induced reductions in frontal and parietal gamma power and frontal beta-2 power relative to the SE group. Both MBSR and SE groups showed reductions in central beta-2 and gamma-band power, suggestive of an overlapping mechanism. MBSR-specific decreases in parietal gamma power were associated with alleviation of anxiety symptoms.Conclusions Findings suggest distinct neurophysiological correlates of mindfulness training implicating the DMN and point to a potential anxiolytic mechanism in adults with ASD.PreregistrationNCT04017793
Chapter
In a recent study employing time production, a number of participants presented aberrant data, which normally would have marked them as being outliers. Given the ongoing discussion in the literature regarding the illusory nature of the flow of time, in this paper we consider whether their data may indicate discontinuity in time perception. We analyze the log-log plots for these outliers, investigating to what degree linearity is preserved for all the data points, as opposed to achieving a better fit using bisegmental regression. The current results, though preliminary, can contribute to the debate regarding the non-linearity of subjective time. It would seem that with longer target durations, the ongoing experience of time can be either one of a subjective slowing down of time (longer time units, increase in slope), or of a subjective speeding up of time (shorter time units, decrease in slope).
Article
Full-text available
Recent research has demonstrated that mindfulness-based meditation facilitates basic aspects of cognition, including memory and attention. Further developing this line of inquiry, here we considered the possibility that similar effects may extend to another core psychological process—instrumental learning. To explore this matter, in combination with a probabilistic selection task, computational modelling (i.e., reinforcement drift diffusion model analysis) was adopted to establish whether and how brief mindfulness-based meditation influences learning under conditions of uncertainty (i.e., choices based on the perceived likelihood of positive and negative outcomes). Three effects were observed. Compared with performance in the control condition (i.e., no meditation), mindfulness-based meditation (1) accelerated the rate of learning following positive prediction errors; (2) elicited a preference for the exploration (vs. exploitation) of choice selections; and (3) increased response caution. Collectively, these findings elucidate the pathways through which brief meditative experiences impact learning and decision-making, with implications for interventions designed to debias aspects of social-cognitive functioning using mindfulness-based meditation.
Article
Women now make up more than half of the physician workforce, but they are disproportionately plagued by burnout. Medicine is a fast-paced stressful field, the practice of which is associated with significant chronic stress due to systems issues, crowding, electronic medical records, and patient case mix. Hospitals and health care systems are responsible for mitigating system-based burnout-prone conditions, but often their best efforts fail. Physicians, particularly women, must confront their stressors and the daily burden of significant system strain when this occurs. Those who routinely exceed their cumulative stress threshold may experience burnout, career dissatisfaction, and second victim syndrome and, ultimately, may prematurely leave medicine. These conditions affect women in medicine more often than men and may also produce a higher incidence of health issues, including depression, substance use disorder, and suicide. The individual self-care required to maintain health and raise stress thresholds is not widely ingrained in provider practice patterns or behavior. However, the successful long-term practice of high-stress occupations, such as medicine, requires that physicians, especially women physicians, attend to their wellness. In this article, we address one aspect of health, resilience, and review six practices that can create additional stores of personal resilience when proactively integrated into a daily routine.
Article
Full-text available
Contemplative practice has demonstrated benefits for mental health and well-being. Most previous studies, however, implemented in-person trainings containing a mix of different, mostly solitary, practices and focused on pre- to post-training outcomes. In this randomized trial, we explore the immediate differential efficacy of two daily app-delivered practices in shifting emotional (valence, arousal) and thinking patterns (thought content on future-past, self-other, positive–negative dimensions). For 10 weeks of daily training, 212 participants (18–65 years) performed either a novel 12-min partner-based socio-emotional practice (Affect Dyad) or a 12-min attention-focused solitary mindfulness-based practice. Using ordinal Bayesian multilevel modeling, we found that both practice types led to more positive affect and higher arousal. However, whereas mindfulness-based practice partly led to a decrease in active thoughts, particularly in future-, other-related and negative thoughts, the Dyad in contrast led to increases in other-related, and positive thoughts. This shift towards more social and positive thoughts may specifically support overcoming ruminative thinking patterns associated with self-related and negative thought content. Overall, these differential findings may help inform the adaptation of scalable app-based mental trainings in different segments of the population with the goal to improve mental health and well-being.
Article
Background: Emotion processing deficits of alexithymia are a transdiagnostic risk factor. While such deficits are malleable, differential efficacy of brief scalable digital mental trainings remains understudied. Methods: This randomized controlled trial probed the efficacy of mindfulness-based (MB) and partner-based socio-emotional Affect Dyad (SE) practice, both supported by weekly coaching sessions, in reducing alexithymia in 285 adult participants. We investigated the predictive role of interoceptive awareness assessed a) before and after daily practice, b) in ecological momentary assessment (EMA) before and after the intervention, and c) weekly during the 10-week intervention. Results: Both interventions reduced emotion processing difficulties on the Toronto Alexithymia Scale (TAS-20). Similarly, both interventions improved interoceptive awareness immediately after daily practice and after the intervention period, yet SE outperformed MB training in EMA assessments. Further, only Dyad practice led to increases in body listening and self-regulatory aspects of the Multidimensional Assessment of Interoceptive Awareness (MAIA) over time, with the latter explaining a decrease in alexithymia. Limitations: Given the subclinical study sample, findings are limited in their generalizability to clinical samples. Conclusions: Findings suggest that app-based socio-emotional and mindfulness-based practices, supported by online coaching sessions, are effective in reducing emotion processing deficits. Dyad training showed advantages on some measures of body awareness, which predicted observed changes in alexithymia. This highlights the potential of using app-based dyadic approaches in the development of emotion awareness and regulation.
Book
Full-text available
The ReSource Project is a unique, large-scale study on Eastern and Western methods of mental training. Over a period of eleven months, participants practice a wide range of mental exercises that are designed to enhance attentional control, body- and self-awareness, healthy emotion regulation, self-care, compassion, empathy, and perspective taking. Overall, the aim of the training is to improve mental health and social skills. It may reduce stress, improve mental clarity, increase life satisfaction, and lead to a better understanding of others’ views, values and actions. This book, intended as a supplement to published and upcoming peer-reviewed publications, provides an overview of the theoretical rationale, training practices, study methods and measures, as well as sample demographics at start of study.
Article
Full-text available
Background: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial. Objectives: To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action. Design: Single-blind, parallel, individual randomised controlled trial. Setting: UK general practices. Participants: Adult patients with a diagnosis of recurrent depression and who were taking m-ADM. Interventions: Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action. Main outcomes measures: The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities. Results: In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation. Conclusions: There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group. Trial registration: Current Controlled Trials ISRCTN26666654. Funding: This project was funded by the NIHR Health Technology Assessment programme and the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula and will be published in full in Health Technology Assessment; Vol. 19, No. 73. See the NIHR Journals Library website for further project information.
Chapter
Full-text available
This chapter discusses the inclusion of phenomenological analysis in the cognitive psychological research of meditation. Different meditation styles involve the specific changes of the mind, such as a long-lasting, vivid, and stable mental imagery in some types of Tibetan meditation. Comparative phenomenological analysis of the Deity Yoga, mandala, Vipashyana, and Rig-pa types of Tibetan meditation was included in designing a cognitive experiment. Results indicate the increase of visual working memory due to the practice of Deity Yoga, suggesting access to the heightened visual processing resources (Kozhevnikov, Louchakova, Josipovic, & Motes. Psychological Science 20(5):645–653, 2009). The phenomenological part of the design, reported here for the first time, included a new methodology termed phenomenological-cognitive mapping (PCM). PCM linked the comparative phenomenological analysis of meditation to the psychological parameters of cognitive testing. PCM proved to be crucial in designing a successful experiment that led to novel findings. In the absence of PCM, isolating the meditation style that causes the optimization of visual-spatial processing and finding at what stage of meditation this happens would not be possible. This chapter argues in favor of including a detailed phenomenological analysis of experience in the cognitive research of meditation, as opposed to using only general classifications such as meditation styles.
Article
Full-text available
Background: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. Methods: In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. Findings: Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. Interpretation: We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. Funding: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Article
Full-text available
As humans we are a highly social species: in order to coordinate our joint actions and assure successful communication, we use language skills to explicitly convey information to each other, and social abilities such as empathy or perspective taking to infer another person’s emotions and mental state. The human cognitive capacity to draw inferences about other peoples’ beliefs, intentions and thoughts has been termed mentalizing, theory of mind or cognitive perspective taking. This capacity makes it possible, for instance, to understand that people may have views that differ from our own. Conversely, the capacity to share the feelings of others is called empathy. Empathy makes it possible to resonate with others’ positive and negative feelings alike — we can thus feel happy when we vicariously share the joy of others and we can share the experience of suffering when we empathize with someone in pain. Importantly, in empathy one feels with someone, but one does not confuse oneself with the other; that is, one still knows that the emotion one resonates with is the emotion of another. If this self–other distinction is not present, we speak of emotion contagion, a precursor of empathy that is already present in babies.
Article
Full-text available
Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = -0.59, 95% CI = -0.12 to -1.06). Effects were demonstrated for depressive symptom severity (Hedges g = -0.73, 95% CI = -0.09 to -1.36), but not for anxiety symptom severity (Hedges g = -0.55, 95% CI = 0.09 to -1.18), for RCTs with an inactive control (Hedges g = -1.03, 95% CI = -0.40 to -1.66), but not where there was an active control (Hedges g = 0.03, 95% CI = 0.54 to -0.48) and effects were found for MBCT (Hedges g = -0.39, 95% CI = -0.15 to -0.63) but not for MBSR (Hedges g = -0.75, 95% CI = 0.31 to -1.81). This is the first meta-analysis of RCTs of MBIs where all studies included only participants who were diagnosed with a current episode of a depressive or anxiety disorder. Effects of MBIs on primary symptom severity were found for people with a current depressive disorder and it is recommended that MBIs might be considered as an intervention for this population.
Article
Full-text available
Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes. Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes. Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups. Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.
Article
Full-text available
Recent work has highlighted that the generation of thoughts unrelated to the current environment may be both a cause and a consequence of unhappiness. The current study used lag analysis to examine whether the relationship between self-generated thought and negative affect depends on the content of the thoughts themselves. We found that the emotional content could strongly predict subsequent mood (e.g. negative thoughts were associated with subsequent negative mood). However, this direct relationship was modulated by the socio-temporal content of the thoughts: thoughts that were past- and other-related were associated with subsequent negative mood, even if current thought content was positive. By contrast, future- and self-related thoughts preceded improvements of mood, even when current thought content was negative. These results highlight the important link between self-generated thought and mood and suggest that the socio-temporal content plays an important role in determining whether an individual's future affective state will be happy or sad.
Article
The present investigation employed a meta-analysis of 179 correlational studies and 37 clinical group comparison studies to examine the association between rumination and symptoms of anxiety and depression. Meta-analytic correlations revealed moderate associations between rumination and symptoms of anxiety and depression that were strongest for brooding and emotion-driven rumination. Symptoms of anxiety and depression also had significant independent effects on overall rumination and emotion-driven rumination. However, worry partially accounted for the associations of both depression and anxiety with rumination. Those with mood and anxiety disorders also reported more rumination than controls, an effect that was amplified by increased comorbidity. Those with mood disorders reported significantly more rumination than those with anxiety disorders. The implications of these findings for a transdiagnostic view of rumination are discussed.