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JACM

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE


Volume 00, Number 00, 2019, pp. 1–16
ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2019.0137

The Many Roads to Mindfulness:


A Review of Nonmindfulness-Based Interventions
that Increase Mindfulness
Tom Xia, MD,1 Hiroe Hu, BS,2,3 Andreea L. Seritan, MD,4,5 and Stuart Eisendrath, MD4,5
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Abstract
Objectives: Mindfulness-based interventions (MBIs) have become increasingly popular for treating various
physical and mental disorders. An increase in mindfulness levels through the teaching of mindfulness medi-
tation is the most well-studied mechanism of MBIs. Recent studies, however, suggest that an increase in
mindfulness is also observed in physical or psychosocial interventions not explicitly labeled as MBIs, or what
the authors call non-MBIs. The authors aimed to review what non-MBIs can increase mindfulness levels despite
not explicitly teaching mindfulness meditation.
Design: The authors conducted a literature search for studies that included a non-MBI study arm measuring
pre- and postintervention mindfulness levels using one of the following eight validated self-reported mind-
fulness questionnaires: Five-Faceted Mindfulness Questionnaire, Mindful Awareness and Attention Scale,
Freiburg Mindfulness Inventory, Toronto Mindfulness Scale, Philadelphia Mindfulness Scale, Kentucky In-
ventory of Mindfulness Skills, Child and Adolescent Mindfulness Measure, and Cognitive and Affective
Mindfulness Scale-Revised. The authors identified 69 non-MBI study arms from 51 independent studies of the
non-MBI itself or as active controls of an MBI under investigation. The authors documented or calculated, if not
provided, effect sizes (ES) for changes in mindfulness levels following these interventions.
Results: Among the 69 non-MBI arms, 36 showed no effect for change in mindfulness (ES <0.20), 3 were
indeterminate (no ES available or unable to calculate), 13 had small effects (0.20 < ES <0.5), 13 had medium
effects (0.50 < ES <0.80), 3 had large effects (0.80 < ES <1.3), and 1 had a very large effect (ES >1.3) for
change in mindfulness.
Conclusions: Analysis of the characteristics of non-MBIs with significant increases in mindfulness levels
suggested some commonalities between MBIs and non-MBIs, shedding light on a spectrum of mindfulness-
related interventions and the possibility that there are many roads to developing mindfulness.

Keywords: mindfulness, meditation, exercise, psychotherapy, review, nonmindfulness-based interventions

Introduction a form of meditation that directs participants to be aware of and


observe their sensations, thoughts, and feelings. This mind-

M indfulness-based interventions (MBIs) have be-


come increasingly popular over the past several decades
as treatment modalities for numerous physical and mental
fulness practice is seen as a core component of the therapy to
help patients change their relationship with their illness and
improve quality of life.3 MBIs, such as mindfulness-based
disorders.1,2 These interventions teach mindfulness meditation stress reduction (MBSR) and mindfulness-based cognitive

1
Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA.
2
College of Osteopathic Medicine, Touro University California, Vallejo, CA.
3
Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco,
CA.
4
Department of Psychiatry, University of California San Francisco, San Francisco, CA.
5
Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.

1
2 XIA ET AL.

therapy ( MBCT), have been shown to decrease symptom relevant articles that fit the inclusion criteria as described
severity and improve well-being in patients with chronic below. Two authors (T.X. and S.E.) conducted independent
pain,4 anxiety, depression,2,5,6 and other illnesses, in- literature searches and then achieved consensus on articles
cluding fibromyalgia, multiple sclerosis, and Parkinson’s included.
disease.7–9
he question of how exactly MBIs work is yet to be an-
Definitions
swered with scientific precision, although the most studied
mechanism is the increase in mindfulness, defined as ‘‘the The authors defined an MBI as any intervention in which
awareness that emerges through paying attention on pur- the practice of mindfulness meditation was a key compo-
pose, in the present moment, and nonjudgmentally to things nent. Yoga and t’ai chi were categorized as MBIs are they
as they are in the service of self-understanding and wis- are utilized in several MBIs such as MBSR and MBCT.
dom.’’10 Mindfulness can be a state of consciousness or a Interventions without mindfulness meditation as a major
personality trait, commonly referred to as ‘‘dispositional component and not Yoga or t’ai chi were categorized as
mindfulness.’’11 Practicing state mindfulness more often non-MBIs.
and for longer durations is believed to lead to increased
dispositional mindfulness, which is the therapeutic rationale Inclusion and exclusion criteria
for MBIs.1
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Early studies comparing MBIs to waitlist or non- Inclusion criteria were as follows:
psychotherapeutic controls consistently show that along with
1. Studies that measured preintervention and postinter-
other mechanisms of action, increased mindfulness mediates
vention levels of mindfulness, either state or trait, using
the therapeutic effects of MBIs.5,12–14 More recent trials have
standardized measures, that is, self-reported question-
compared MBIs to active control arms consisting of various
naires, as mentioned above (FFMQ, MAAS, FMI, TMS,
interventions that do not explicitly teach mindfulness prin-
PHLMS, KIMS, CAMM, CAMS), and
ciples and do not have the goal of increasing levels of
2. Studies that included at least one intervention arm or
mindfulness, interventions the authors will call non-MBIs.
active control arm that was defined as a non-MBI
These non-MBIs typically match the practice time, group
interaction, and intervention duration of that of MBIs. The exclusion criteria are as follows:
Interestingly, despite principles of mindfulness only being
1. Studies on MBIs or non-MBI that did not measure pre-
taught in the MBI arm, often both intervention and active
and postintervention levels of mindfulness
control arms show increases in self-reported mindful-
2. Studies on MBIs that only used waitlist or treatment-
ness.15,16 Moreover, mindfulness has been postulated to be a
as-usual (TAU) control and no active non-MBI control
personality trait that varies between individuals as certain
arm.
people obtain high scores on self-reported measures of dis-
positional mindfulness despite never having practiced mind-
fulness meditation.1,11,17
Data analysis
The authors aim to review the scientific literature to de-
lineate what interventions have been associated with in- Pre- and postintervention levels of mindfulness were
creases in mindfulness aside from formal MBIs. Specifically, documented. Effect sizes (ES) of changes in mindfulness
the authors conducted a literature review of studies on non- were documented if reported by the study, otherwise they
MBIs and studies on MBIs with non-MBI control arms that were calculated by the equation: Cohen’s d = M1 - M2/
measured preintervention and postintervention levels of SDpooled whenever the relevant data were available.26 For
mindfulness. By discovering and analyzing non-MBIs asso- non-MBI studies that included at least one arm with an MBI,
ciated with increased mindfulness levels, this study presents a similar analyses were performed for MBI arms to compare
list of interventions that may offer similar benefits to those of ES between MBIs and non-MBIs.
MBIs through increased mindfulness.
Questionnaires
Materials and Methods
The descriptors and references to the self-reported ques-
The search process
tionnaires used in their literature research are summarized in
The authors conducted a review of articles in PubMed from Table 1 with notable exceptions listed in the comments
first available (August 2002) to October 2016 using the search column. Most of these questionnaires measure dispositional
terms: Mindfulness AND ([Five Facet Mindfulness Ques- mindfulness, with the exception of the TMS, which mea-
tionnaire] FFMQ OR [Mindful Attention and Awareness sures state mindfulness.21 The questionnaires that measure
Scale] MAAS OR [Freiburg Mindfulness Inventory] FMI dispositional mindfulness are further divided into ones that
OR [Toronto Mindfulness Scale] TMS OR [Philadelphia are unidimensional (single scoring system) or multidimen-
Mindfulness Scale] PHLMS OR [Kentucky Inventory of sional (both composite and individual subscale scoring are
Mindfulness Skills] KIMS OR [Child and Adolescent reported). The KIMS, FFMQ, and PHLMS are multidi-
Mindfulness Measure] CAMM OR [Cognitive and Affective mensional trait mindfulness measures, whereas the MAAS,
Mindfulness Scale] CAMS). FMI, and CAMS are unidimensional.
These search terms were selected to include the most com- Most questionnaires are designed for adults, with or
mon validated instruments that measure mindfulness.11,19–25 without previous meditation experiences, with exceptions
In addition, reference lists were inspected for additional noted in the comments column for the FMI and CAMM.
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Table 1. Characteristics of Self-Reported Questionnaires that Measure Mindfulness


Cronbach’s
Questionnaire Items Scale Scoring Subscales alpha Comments References
18
Five Facet Mindfulness 39 5-point Composite and (1) Observe 0.75–0.91
Questionnaire Likert Individual (2) Describe
(FFMQ) subscale scoring (3) Act with awareness
(4) Nonjudging
(5) Nonreactivity
11
Mindful Attention and Awareness 15 6-point Single scoring None 0.82
Scale (MAAS) Likert
20
Freiburg Mindfulness Inventory (FMI) 30 4-point Single scoring None 0.93–0.94 Designed for experienced
Likert meditators
21
Toronto Mindfulness Scale (TMS) 13 5-point Composite and (1) Curiosity 0.91–0.93 Measures immediate

3
Likert Individual (2) Decentering experience after meditation
subscale scoring (i.e., state mindfulness)
22
Philadelphia Mindfulness Scale 20 5-point Composite and (1) Awareness 0.81–0.85
(PHLMS) Likert Individual (2) Acceptance
subscale scoring
23
Kentucky Inventory of Mindfulness 39 5-point Composite and (1) Observe 0.76–0.91
Skills (KIMS) Likert Individual (2) Describe
subscale scoring (3) Accept without
judgment
(4) Act with awareness
24
Child and Adolescent Mindfulness 10 5-point Single scoring None 0.80 For school-age children
Measure (CAMM) Likert and adolescents
25
Cognitive and Affective Mindfulness 12 4-point Single scoring None 0.74–0.80
Scale-Revised (CAMS-R) Likert
4 XIA ET AL.

Internal consistencies (calculated as Cronbach’s Alpha) for employees,34 wilderness excursion for university students,27
all questionnaires are summarized in Table 1. heart coherence training for patients with chronic muscu-
loskeletal pain (but not healthy adults),35 self-help inter-
Results ventions for people with high neuroticism,36 heart rate
variability biofeedback for young adults with elevated stress
Literature search levels,30 health enhancement program for patients with
Their search terms returned 1890 articles, and 51 studies treatment resistant depression,15 health education program
were found to meet their inclusion criteria. The vast ma- modeled on ‘‘10 keys’’ of healthy aging for older adults with
jority of studies that returned on their search terms involved chronic low back pain,37 reading for healthy pregnant
studying MBIs either without controls or with only a waitlist women,38 mind–body bridging for cancer survivors,39 and a
or TAU controls. As such, they were excluded from their diet-exercise program for obese individuals.40
study due to not having a non-MBI arm. Studies that had Finally, the 13 interventions that showed a small effect
non-MBI arms but did not report pre- and postintervention were mantram repetition for veterans with PTSD,41 gyro-
levels of mindfulness or only measured partial levels of kinesis for college students,42 Aikido for university stu-
mindfulness (utilizing certain subscales within a mindful- dents,43 exercise training for sedentary healthy males,44
ness self-reported questionnaire) were also excluded. affect-consciousness training for patients with psychosis,45
cognitive behavioral therapy (CBT) for insomnia for cancer
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survivors with insomnia,46 aerobic exercise for patients with


Study characteristics generalized social anxiety disorder,47 cognitive behavioral
The 51 studies that met the inclusion criteria fell into one group therapy for patients diagnosed with social anxiety
of two categories: disorder,48 food construal messages for college students,49
behavioral activation for depressed college students,50 tango
1. Seventeen studies investigated the pre- and post- for people with self-declared depression,51 supportive ex-
intervention levels of mindfulness during a non-MBI. pressive group therapy for distressed breast cancer survi-
These studies did not have a comparison MBI group. vors,52 and the eight point program involving mantram
2. Thirty-four studies investigated the pre- and post- meditation for college students.53
intervention levels of mindfulness during a single
MBI, compared with one or more non-MBIs that
served as the active control. Discussion

Sample size ranged from 16 to 282, with a total of 4690 The present study was undertaken to answer an important
participants. The combined 51 studies incorporated 69 total question in mindfulness research: do non-MBIs (and which
non-MBI modalities, which ranged from aerobic exercise ones specifically) increase mindfulness levels? Their find-
to muscle relaxation, equine therapy, and art therapy, as ings strongly suggest that certain non-MBIs can indeed have
summarized in Tables 2 and 3. Non-MBIs were performed a significant effect on increasing mindfulness in a wide
with various individuals, either medically healthy or suf- range of both nonclinical and clinical participants. In fact,
fering from anxiety disorders, chronic pain, major depres- 30 of the 69 non-MBIs showed at least a small effect for
sive disorder, psychosis, insomnia, substance use, or increase in mindfulness (Tables 2 and 3). With high dropout
obesity. Studies also included participants of different ages, rates being an issue in meditation-related interventions and
ranging from age 9 to 88 (Tables 2 and 3). research suggesting that more individualized modalities may
be beneficial, non-MBIs may offer people unaware, unin-
volved, or uninterested in traditional MBIs the opportunity
Change in mindfulness levels after MBIs and non-MBIs
to reap the same benefits of developing mindfulness.54
The authors paid particular attention to the change in The non-MBIs researched ranged from interventions that
mindfulness levels as a result of these 69 non-MBI modal- share much overlap with MBIs (other forms of medita-
ities, either as stand-alone study (Table 2) or used as active tion, mind–body interventions) to interventions traditionally
control in an MBI study (Table 3). Among the 69 non-MBIs, thought of as unrelated to mindfulness. Not surprisingly,
36 showed no effect for change in mindfulness (ES <0.20), 3 nonmindfulness forms of meditation were associated with
were indeterminate (unreported ES and unable to calculate), increased mindfulness levels. Mantram meditation utilizes
13 had small effects (0.20 < ES <0.5), 13 had medium ef- attention to specific sounds or phrases to concentrate the
fects (0.50 < ES <0.80), three demonstrated large effects mind, and loving-kindness meditation may use repeated
(0.80 < ES <1.3), and 1 had a very large effect (ES >1.3). phrases to cultivate compassion and benevolence.29,41,53
The one intervention with very large effect for increased Although these forms of meditation and mindfulness
mindfulness was the group hiking trip for 14-year-old meditation may differ in goals and specific techniques, their
children.27 The three interventions that demonstrated large shared attention regulation may have contributed to the fact
effects were equine-assisted therapy for PTSD patients,28 that all three practices are associated with increased mind-
loving kindness meditation for veterans with PTSD,29 and fulness levels. In fact, functional neuroimaging studies show
physical exercise for young adults with elevated stress.30 activity in common brain areas consistently among distinct
The 13 interventions with medium effect for increased forms of meditation.55
mindfulness were Pilates for college students,31 both in- Also expected was that many of the non-MBIs associated
person and Internet-delivered intensive short-term dynamic with increased mindfulness were mind–body practices, in-
psychotherapy for people with medically unexplained terventions where a major component of the practice is di-
pain,32,33 web-based happiness training for healthy work recting mental awareness to the body, breath, or movement
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Table 2. Characteristics of Studies on Nonmindfulness-Based Interventions


Preintervention Postintervention
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Bormann et al. Veterans with PTSD Mantram repetition program MAAS 71 47.5 51.6** 0.46 Mantram repetition program
(2014)41 group had greater increase
in mindful attention, which
mediated improvements in
PTSD symptoms, depression,
and improved psychologic
well-being
TAU 70 48.1 46.4
Burton et al. Patients with social Virtual reality MAAS 32 4.12 4.03 -0.09 Both groups were associated
(2013)80 anxiety disorder with decreased fear of
negative evaluation
Exposure therapy group 33 3.95 4.03 0.08
Caldwell et al. Undergraduate students Pilates method FFMQ 169 131 140* NR Only the Pilates group had
(2013)31 recreational exercise class 139 131 131 NR increase in mindfulness
scores and increases related
to self-efficacy, perceived
stress, and mood
Chavooshi People with unexplained In-person intensive short-term MAAS 42 35.4 45.1*** 0.75 The in-person group had lower

5
et al. (2017)33 pain dynamic psychotherapy pain intensity, depression,
Internet-delivered intensive 39 33.2 31.3 -0.14 anxiety, and stress and greater
short-term dynamic increase in emotional regulation
psychotherapy functioning, mindfulness, and
quality of life
Chavooshi Patients with medically Internet delivered intensive MAAS 50 36.8 45.1** 0.54 The ISTDP group showed
et al. (2016)32 unexplained pain short-term dynamic reduced pain symptoms,
psychotherapy (ISTDP) depression, anxiety, stress,
and increased emotion regulation
functioning, mindfulness, and
quality of life
TAU 50 35.2 31.3 -0.27
Chesak et al. New nurses Stress-management and MAAS 19 4.42 4.57 0.19 The SMART group showed
(2015)56 resiliency training increased mindfulness and
(SMART) resilience, as well as decreased
stress and anxiety, but was not
significantly different than
controls
Stress education 21 3.85 3.80 -0.09
Earles et al. Patients with PTSD Equine-assisted therapy FFMQ 16 110 123*** 1.28 Patients after EAT showed
(2015)28 (EAT) decreased PTSD symptoms,
less severe emotional response
to trauma, less anxiety, and
fewer symptoms of depression
(continued)
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Table 2. (Continued)
Preintervention Postintervention
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Feicht et al. Work employees Web-based happiness training FMI 54 35.9 39.5** 0.54 The happiness training group
(2013)34 showed improvement in
happiness, satisfaction,
quality of life, mindfulness,
flourishing, and recovery
experience while decreasing
perceived stress
Waitlist 47 35.0 35.2 0.03
Kearney et al. Veterans with PTSD Loving kindness meditation FFMQ 42 106 125* 0.80 Loving kindness meditation
(2013)29 group showed decreased
PTSD and depression symptoms
Leong et al. Patients with major Repetitive transcranial FFMQ 32 111 114 Patients that received rTMS
(2013)57 depressive episode magnetic stimulation showed decreases in depression
(rTMS) and anxiety and increases in
nonreactivity of FFMQ and
decentering of Experiences

6
Questionnaire.
Lothes et al. University students with Aikido KIMS 12 135 142 0.48 Aikido training was associated
(2013)43 no previous martial with increased mindfulness
arts training scores
No intervention control KIMS 20 126 121 -0.42
Aikido MAAS 12 67.0 72.0 0.19
No intervention control MAAS 20 56.0 52.0 -0.26
Moore et al. College students Writing repeated traumatic KIMS 159 122 119 -0.22 Neither group showed changes
(2009)58 narratives in mental health or
Writing unemotional daily 74 122 122 0 experiential avoidance
event narratives after the intervention
Mothes et al. Sedentary healthy males Exercise training + MAAS 40 4.45 4.57* 0.28 Dispositional mindfulness
(2014)44 relaxation training 41 4.34 4.27 0.19 increased in exercise group
but not relaxation or waitlist
groups and were moderately
correlated with improvements
in mental health
Waitlist 37 4.51 4.49 -0.03
(continued)
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Table 2. (Continued)
Preintervention Postintervention
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Mutz and 14 Year olds Group hiking trip MAAS 12 4.41 4.81*** 1.32 Participants had increased
Muller mindfulness and life
(2016)27 satisfaction and decreased
demand of Perceived Stress
Questionnaire
University students Wilderness excursion MAAS 15 3.93 4.18* 0.54 Participants had increased
mindfulness, life satisfaction,
happiness, self-efficacy,
and decreased perceived stress
Control 7 4.15 4.14 -0.02

7
Potash et al. Health care workers in Art therapy–based supervision FFMQ 56 116 116 0 Art-therapy based supervision
(2014)59 the field of death, group group showed decrease in
dying, and Skill-based supervision group 57 115 116 0.10 exhaustion and death anxiety
bereavement and increase in emotional
awareness
Soer et al. Patients with chronic Heart coherence training MAAS 10 53.0 55.0 0.60 Both groups had increase in
(2015)35 musculoskeletal pain FFMQ 10 135 135 0.40 heart coherence scores
Healthy people Heart coherence training MAAS 15 62.0 58.0 -0.40 but effect sizes for change
FFMQ 15 129 134 0.10 on MAAS and FFMQ
were low
Soler et al. Healthy people Ayahuasca psychedelic brew FFMQ 25 137 146* NR Plant intake led to increase
(2016)60 in two mindfulness facets,
as well as decentering
*p < 0.05, **p < 0.01, ***p < 0.001.
FFMQ, Five Facet Mindfulness Questionnaire; FMI, Freiburg Mindfulness Inventory; KIMS, Kentucky Inventory of Mindfulness Skills; MAAS, Mindful Attention and Awareness Scale; NR, not
reported; PTSD, post-traumatic stress disorder; TAU, treatment-as-usual.
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Table 3. Characteristics of Studies Comparing Mindfulness-Based Interventions to Nonmindfulness-Based Interventions


Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Armstrong and People with high Mindfulness-based cognitive FFMQ 17 108 133*** 1.25 MBCT group had lower
Rimes (2016)36 neuroticism therapy (MBCT) neuroticism, reduced
rumination, and increased
self-compassion and decentering
compared to control
Self-help interventions 17 102 116* 0.73
Banks et al. Healthy adults Home mindfulness meditation FFMQ 40 130 132 0.16 Mindfulness meditation
(2015)61 failed to increase memory
or decrease mind wandering
but decreased stress related
working memory impairments
Muscle relaxation and body scan 40 124 126 0.15
Bergen-Cico Undergraduate students Mindfulness-based stress KIMS 72 126 133* 0.36 MBSR group showed
et al. (2013)62 reduction (MBSR) improvements in mindfulness
Class w/discussion about mindful 47 123 123 0.03 and self-compassion
and present centered awareness compared to control class
MBSR PHLMS 72 64.9 67.5 0.43
Class w/discussion about mindful 47 63.2 63.1 -0.01
and present centered awareness

8
Bieling et al. MDD patients in MBCT TMS 18 9.93 13.2 0.47 The MBCT group showed
(2012)63 remission curiosity increased decentering and
wider experiences compared
to controls
Medication 14 13.3 11.1 -0.51
Placebo 15 11.6 10.0 -0.25
MBCT TMS 18 13.5 19.7* 0.90
decentering
Medication 14 16.7 14.1 -0.57
Placebo 15 12.4 12.0 -0.07
Britton et al. Healthy sixth-grade Asian history course w/daily CAMS-R 33.0 33.0 0 Both groups had decreased
(2014)64 students mindfulness meditation practice scores on Youth Self-Report
African history course with 32.9 32.6 0 and CAMS-R, but meditators
matched experiential activity were less likely to develop
suicidal ideation or thoughts
of self-harm
de Bruin et al. Young adults with Mindfulness meditation FFMQ 27 77.9 83.7 0.27 All three interventions were
(2016)30 elevated stress Physical exercise 25 74.6 82.8** 0.99 equivalent in improving
levels Heart rate variability 23 77.3 83.7* 0.68 attention control, executive
biofeedback+ functioning, mindful
awareness, self-compassion,
and worrying
(continued)
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Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Caldwell et al. College students Taiji Quan FFMQ 38 131 139 0.42 All groups were showed
(2010)42 increase in mindfulness
and improved sleep
Pilates 80 130 139*** 0.54
Gyrokinesis 48 128 132 0.27
Chiesa et al. Depressed patients who MBCT MAAS 9 3.16 2.98 -0.20 The MBCT group showed
(2012)65 did not achieve significantly improved
remission after 8 weeks scores in depression and
of antidepressants psychologic general well-being
Psycho-education 7 2.44 3.42 0.72
Chiesa et al. Patients with MDD who MBCT FFMQ 23 117 128* 0.76 MBCT had higher improvements
(2015)66 did not achieve Psycho-educational control 20 120 121 0.05 in depression scores,
remission after as well as quality of life
antidepressant and mindfulness
treatment
Eisendrath Patients with treatment MBCT FFMQ 87 107 126*** 0.89 MBCT showed greater
et al. (2016)15 resistant depression Health enhancement program 86 109 122*** 0.55 depression reduction and
(HEP) response and equal remission

9
rates compared to HEP
Eliassen et al. Patients with psychoses MBSR FFMQ 27 141 143 0.17 Both interventions improved
(2016)45 Affect-consciousness training 23 142 146 0.38 ward atmosphere
Garland et al. Cancer survivors with mindfulness-based cancer FFMQ 32 129 130 0.09 Both CBT-I and MBCR reduced
(2014)46 insomnia recovery (MBCR) insomnia severity
Cognitive behavior therapy 40 128 132 0.42
for insomnia (CBT-I)
Garland et al. Men with substance use, MORE FFMQ 64 125 139** 0.53 MORE showed greater
(2016)67 psychiatric disorders, Cognitive-behavioral therapy 64 130 130 -0.01 improvement in substance
or trauma histories (CBT) craving, post-traumatic stress,
TAU 52 127 129 0.10 and negative effect than CBT
Goldberg et al. Healthy people without MBSR FFMQ 34 107 116** 0.54 FFMQ facets correlated with
(2016)68 meditation experience HEP 36 113 122*** 0.66 psychosocial symptoms
Waitlist 36 107 111* 0.24 and well-being, and both
facets increased in both MBSR
and HEP relative to controls
Goldin et al. Patients with generalized MBSR KIMS 31 111 127* 1.12 MBSR produced larger decreases
(2012)47 social anxiety disorder Aerobic exercise 26 111 118 0.45 in negative self-views and
similar increases in positive
self-views
(continued)
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Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Guardino et al. Pregnant women Mindful awareness practices FFMQ 24 120 134*** 1.02 Both groups had increased
(2014)38 classes (MAPS) mindfulness and decreased
Reading 23 124 135* 0.69 perceived stress and state
anxiety, but the MAPS
group had larger decreases
in pregnancy specific anxiety
Hou et al. Caregivers of persons MBSR FFMQ 70 123 125 0.11 MBSR group had greater decrease
(2014)69 with chronic in depressive and anxiety
conditions symptoms and greater increase
in self-efficacy and mindfulness.
Self-help booklet for health 71 119 118 0.08
education
Kingston et al. Healthy university Mindfulness session KIMS 21 3.06 3.29* 0.76 Pain tolerance increased only
(2007)70 students in the mindfulness group,
and diastolic blood pressure
decreased in both groups
Guided visual imagery session 21 3.23 3.26 0.09
Kocovski et al. Patients diagnosed with mindfulness and acceptance- FMI 53 29.0 32.8** 0.35 MAGT and CBGT were equally
(2013)48 social anxiety disorder based group therapy better than control at reducing

10
(MAGT) social anxiety
cognitive behavioral group 53 29.4 31.5 0.26
therapy (CBGT)
Waitlist 31 30.4 30.4 0.01
Lipschitz et al. Cancer survivors Mindfulness meditation FFMQ 11 125 135 0.42 Mindfulness meditation and
(2015)38 MBR groups had greater
reduction in sleep problems
than SHE
Mind–body bridging (MBR) 10 129 142 0.79
Sleep hygiene education (SHE) 9 135 130 -0.21
Mantzios and Undergraduate students Meditation MAAS 50 3.99 4.22 0.29 At the end of intervention,
Wilson (2014)49 Food construal 48 3.61 3.85 0.29 weight loss was equal for
both groups, but food
construal diaries performed
better at 3-month follow-up
Mason et al. Obese individuals Mindfulness-based weight loss MEQ 78 2.70 2.90*** 0.57 The mindfulness group had
(2016)40 intervention increased mindful eating
and maintenance of fasting
glucose compared to the
active control
Diet-exercise program+ 76 2.60 2.80*** 0.57
(continued)
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Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
McClintock Adults with high levels Mindfulness therapy for FFMQ 24 120 144*** 1.21 MT-MID group showed
et al. of maladaptive maladaptive interpersonal improvements in
(2015)71 dependency dependency (MT-MID) interpersonal dependency
compared to controls
Writing article summaries of 24 112 112 -0.02
research articles
McIndoo et al. Depressed college Individual MBSR FFMQ 20 108 120* 0.68 Both groups had
(2016)50 students Behavioral activation 16 110 113 0.23 improvements in
Waitlist 14 109 109 -0.01 depression, rumination,
stress, and mindfulness
relative to controls
Morone et al. Older adults with chronic Mind–body program modeled MAAS 140 4.60 4.50 -0.14 Mind–body program
(2016)37 low back pain after MBSR improved function short-term
Health education program 142 4.40 4.50 0.14 and pain long-term but not
modeled on ‘‘10 keys’’ of function long-term
healthy aging
Noggle et al. Grade 11 or 12 students Yoga CAMM 36 53.9 53.4 -0.06 Yoga group showed improved
(2012)72 total mood disturbance, while
physical exercise showed

11
worsened mood disturbance
Physical exercise 15 52.3 49.4 -0.42
Pinniger et al. People with self-declared Meditation MAAS 16 3.51 3.81 0.34 Depression was reduced in tango
(2012)51 depression Tango 21 3.71 4.13 0.32 and meditation groups and
Waitlist 29 3.31 3.45 0.17 stress was reduced only in
tango
Robins et al. Women with increased t’ai chi MAAS 31 3.95 4.24 0.33 t’ai chi group had decreased
(2015)73 risk of cardiovascular fatigue, granulocyte colony
disease stimulating factor, interferon
gamma, tumor necrosis factor,
interleukin 8, and interleukin 4
Waitlist 32 3.79 3.77 -0.02
Schellekens Distressed breast cancer Mindfulness based cancer MAAS 69 3.81 4.16* 0.38 MBCR group had greater
et al. survivors recovery (MBCR) improvement in mood
(2017)52 Supportive expressive group 70 3.88 4.04 0.21 disturbance, stress symptoms,
therapy (SET) and social support but not
quality of life or mindfulness
compared to SET
Schmidt et al. Females with MBSR FMI 53 36.4 37.7 0.23 Only MBSR group had modest
(2011)74 fibromyalgia improvement in quality of life
Muscle relaxation and stretching 56 35.9 35.1 -0.09
waitlist 59 36.7 36.1 -0.08
(continued)
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Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Schonert-Reichl Elementary school Mindfulness-based emotional MAAS-C 48 4.34 4.68* 0.42 The mindfulness group showed
et al. (2015)75 children learning greater improvements in
cognitive control, stress
physiology, empathy,
perspective-taking, emotional
control, optimism, school self-
concept, and mindfulness, as
well as greater decreases in
depression and aggression
Social responsibility program 51 4.56 4.26 -0.40
Shapiro et al. Undergraduate college MBSR MAAS 15 53.3 60.4 0.55 Both groups were associated
(2008)53 students with increased mindfulness
and mindfulness mediated
decreased stress and
rumination
Eight point program—mantram 14 54.7 59.2 0.33
meditation
Silverstein et al. College women Meditation course and practice FFMQ 14 124 140** 1.28 The meditation group was faster
(2011)76 at registering physiologic

12
responses to sexual stimuli,
had improved attention, self-
judgment, anxiety symptoms,
and depression
Religious studies course 16 133 135 0.20
Meditation course and practice MAAS 14 3.80 4.30* 1.00
Religious studies course 16 4.10 4.00 -0.25
Smith et al. Healthy adults MBSR MAAS 36 3.68 4.12* 0.49 MBSR had better outcomes in
(2008)77 mindfulness, energy, pain, and
a trend for binge eating
Cognitive-behavioral stress 14 4.30 3.75 -0.55
reduction
Zeidan et al. Healthy college students Mindfulness meditation FMI 24 43.4 50.0* 0.70 Both groups had improved
(2010)78 mood, but only the meditation
group showed reduced fatigue,
anxiety, and increased mindfulness
Group audiobook listening 25 47.0 48.4 0.16
*p < 0.05, **p < 0.01, ***p < 0.001.
CAMS-R, Cognitive and Affective Mindfulness Scale- Revised; CAMM, Child and Adolescent Mindfulness Measure; FFMQ, Five Facet Mindfulness Questionnaire; FMI, Freiburg Mindfulness
Inventory; KIMS, Kentucky Inventory of Mindfulness Skills; MAAS, Mindful Attention and Awareness Scale; MAAS-C, Mindful Attention and Awareness Scale-Children; MBCT, Mindfulness-based
Cognitive Therapy; MBSR, Mindfulness-based Stress Reduction; MEQ, Mindful Eating Questionnaire; PHLMS, Philadelphia Mindfulness Scale; TAU, treatment-as-usual; TMS, Toronto Mindfulness
Scale.
REVIEW OF NONMINDFULNESS-BASED INTERVENTIONS 13

despite not having a formal mindfulness meditation teaching vention had a medium effect of increasing mindfulness in
component (Tables 2 and 3). These mind–body interven- the patients but no effect on healthy people. It is possible
tions, such as Pilates, mind–body bridging, gyrokinesis, and that medically ill patients are more sensitive to mindfulness-
heart-coherence training, at times demonstrated similar in- developing interventions or more motivated to participate in
creases in mindfulness to MBIs.39 These results make sense nonpharmacologic approaches.
as mind–body practices not only direct attention to the body The present investigation is limited by the great variation
and breath similarly to mindfulness meditation but also play of studies reviewed. The non-MBIs reviewed differed in
a role in many MBIs either as mindful movement or demographics, practice length, level of supervision, scales
yoga.2,5,6 used to measure mindfulness levels, and many other non-
Interestingly, regular exercises not considered mind–body specific factors. As previously mentioned, the line between
practices were associated with increased mindfulness levels MBIs and non-MBIs is not well defined, and it seems almost
as well. In fact, 22 of the 69 non-MBI arms included some inevitable that some instructors of non-MBIs (such as CBT
form of exercise, such as aerobics, wilderness hikes, recre- or physical exercise) may teach in a mindful, awareness-
ational exercise, and tango (Tables 2 and 3). Interventions focused way. While the authors argue that mindfulness in-
such as physical exercise for young adults with elevated terventions lie on a spectrum, it becomes difficult to draw
stress levels30 and a group hiking trip for 14-year-old further conclusions from their data due to overlapping
healthy boys27 were associated with some of the greatest groups. Future studies will be needed to understand the
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increases in mindfulness among all interventions. mechanism that pervades all interventions on this mindful-
How these interventions without formal mindfulness train- ness spectrum.
ing can lead to such large increases in ES remains to be With regards to mindfulness scales, one scale measured
understood. One explanation could be that physical exercise state mindfulness while the remainder assessed trait mind-
results in conscious somatosensory cognizance of body fulness (Table 1). Some scales were multidimensional,
movements, in turn leading to attention regulation and higher measuring multiple subscale components of mindfulness,
body awareness.79 It is possible that this heightened attention and some were unidimensional (Table 1). Even among the
and awareness translate into increased mindfulness. multidimensional scales like the FFMQ, PHLMS, and
Given these results, it seems likely that mindfulness op- KIMS, different subscales were used (Table 1). Although
erates on a spectrum and the somewhat arbitrary categori- their review documents preintervention and postintervention
zations of MBI, mind–body, or other intervention share levels of mindfulness, the variation in mindfulness scales
much overlap. While some people require dedicated mind- makes it possible that these studies are not measuring the
fulness meditation to improve mindfulness, others may de- same entity. In fact, Aikido was associated with a small
velop such skills through awareness-based movement or just effect (ES 0.48) of change in mindfulness when measured
ordinary activities (Tables 2 and 3). Interventions such as by the MAAS but no effect (ES 0.19) when using the
tango and Aikido blur the lines between mind–body inter- KIMS.43
vention and other non-MBIs as they may be considered In addition, insufficient information was available re-
mere exercise to some people but a more purposeful or even garding the information presented to study participants
contemplative practice to others. With this mindfulness during the consent process; as such, it is difficult to ascertain
spectrum concept, the authors hope to illuminate the fact if the control group interventions were presented as non-
that interventions not traditionally associated with mind- mindfulness interventions to participants. This could have
fulness have a place on this spectrum and have the potential influenced the participants’ expectations and perceptions
to help develop mindfulness. regarding the control group interventions, and it may have
The delivery method of non-MBIs appears to moderate affected their self-reporting of mindfulness levels. Studies
changes in mindfulness levels as well. Burton et al. found have also shown that meditators and nonmeditators assess
that exposure group therapy was associated with increased their levels of mindfulness differently, further implicating
mindfulness levels in patients with social anxiety disorder, self-report questionnaires as limited tools for measuring
but a simulation using virtual reality did not produce similar mindfulness.81,82
effects.80 Similarly, Chavooshi et al. found that in-person A potential solution to this problem is incorporating more
intensive short-term dynamic psychotherapy produced a objective measures of mindfulness83 in addition to self-
medium effect of increased mindfulness, but the Internet- reported questionnaires to accurately capture all the com-
delivered version of the same therapy was not associated ponents of mindfulness. Objective measures, such as using
with any changes in mindfulness.32 In both studies, the in- breath counting, electroencephalography, and functional
tervention arms differed only in how the specific therapies magnetic resonance imaging, and using one standardized
were delivered, group therapy versus virtual reality and in- measurement tool may further their understanding of
person therapy versus Internet-delivered therapy. mindfulness as a construct.83–85
Finally, participant selection may have influenced the
changes in mindfulness levels as well. The non-MBI studies
Conclusions
and MBI studies with non-MBI control arms were per-
formed with many different participants, ranging from A broad spectrum of non-MBIs, ranging from various
school aged children to older adults, some healthy and some meditations to exercise and psychotherapies, has been
with numerous medical conditions (Tables 2 and 3). Soer shown to increase mindfulness levels. Although they do not
et al. measured the effect of heart coherence training on directly teach mindfulness meditation, these strategies may
mindfulness, and it included both patients with chronic impart skills similar to those taught by MBIs and thus
musculoskeletal pain and healthy adults.35 The same inter- benefit people who do not participate in structured
14 XIA ET AL.

mindfulness practices. With so many non-MBIs that in- after mindfulness-based cognitive therapy. J Nerv Ment Dis
crease mindfulness levels, it seems that mindfulness medi- 2008;196:630–633.
tation is one of many paths to improving mindfulness, one 14. Shahar B, Britton WB, Sbarra DA, et al. Mechanisms of
of many roads leading to the same destination. Future change in mindfulness-based cognitive therapy for de-
studies should explore the mechanisms through which non- pression: Preliminary evidence from a randomized con-
MBIs achieve this effect and strive to find the common trolled trial. Int J Cogn Ther 2010;3:402–418.
denominator across MBIs and non-MBIs that increase 15. Eisendrath SJ, Gillung E, Delucchi KL, et al. A randomized
mindfulness levels. controlled trial of mindfulness-based cognitive therapy for
treatment-resistant depression. Psychother Psychosom 2016;
Ethics Approval 85:99–110.
16. Williams JM, Crane C, Barnhofer T, et al. Mindfulness-
This article does not contain any studies with human based cognitive therapy for preventing relapse in recurrent
participants or animals performed by any of the authors. depression: A randomized dismantling trial. J Consult Clin
Psychol 2014;82:275–286.
Author Disclosure Statement 17. Creswell JD, Way BM, Eisenberger NI, et al. Neural cor-
relates of dispositional mindfulness during affect labeling.
No competing financial interest exists.
Psychosom Med 2007;69:560–565.
18. Christopher MS, Neuser NJ, Michael PG, Baitmangalkar A.
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References
Exploring the psychometric properties of the five facet
1. Kabat-Zinn J. Mindfulness-based interventions in context: mindfulness questionnaire. Mindfulness 2012;3:124–131.
Past, present, and future. Clin Psychol Sci Pract 2003;10: 19. Baer RA, Smith GT, Hopkins J, et al. Using self-report
144–156. assessment methods to explore facets of mindfulness. As-
2. Teasdale JD, Segal ZV, Williams JMG, et al. Prevention of sessment 2006;13:27–45.
relapse/recurrence in major depression by mindfulness- 20. Walach H, Buchheld N, Buttenmüller V, et al. Measuring
based cognitive therapy. J Consult Clin Psychol 2000;68: mindfulness—the Freiburg Mindfulness Inventory (FMI).
615–623. Pers Individ Dif 2006;40:1543–1555.
3. Kabat-Zinn J. An outpatient program in behavioral medi- 21. Lau MA, Bishop SR, Segal ZV, et al. The Toronto mind-
cine for chronic pain patients based on the practice of fulness scale: Development and validation. J Clin Psychol
mindfulness meditation: Theoretical considerations and 2006;62:1445–1467.
preliminary results. Gen Hosp Psychiatry 1982;4:33–47. 22. Cardaciotto L, Herbert JD, Forman EM, et al. The assess-
4. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of ment of present-moment awareness and acceptance: The
mindfulness-based stress reduction vs cognitive behavioral Philadelphia mindfulness scale. Assessment 2008;15:204–
therapy or usual care on back pain and functional limita- 223.
tions in adults with chronic low back pain: A randomized 23. Baer RA, Smith GT, Allen KB. Assessment of mindfulness
clinical trial. JAMA 2016;315:1240–1249. by self-report: The Kentucky inventory of mindfulness
5. Kuyken W, Warren FC, Taylor RS, et al. Efficacy of skills. Assessment 2004;11:191–206.
mindfulness-based cognitive therapy in prevention of de- 24. Greco LA, Baer R, Smith GT. Assessing mindfulness in
pressive relapse: An individual patient data meta-analysis children and adolescents: Development and validation of
from randomized trials. JAMA Psychiatry 2016;73:565–574. the child and adolescent mindfulness measure (CAMM).
6. Hofmann SG, Sawyer AT, Witt AA, et al. The effect of Psychol Assess 2011;23:606–614.
mindfulness-based therapy on anxiety and depression: A meta- 25. Feldman G, Hayes A, Kumar S, et al. Mindfulness and
analytic review. J Consult Clin Psychol 2010;78:169–183. emotion regulation: The development and initial validation
7. Baer RA. Mindfulness training as a clinical intervention: A of the cognitive and affective mindfulness scale-revised
conceptual and empirical review. Clin Psychol Sci Pract (CAMS-R). J Psychopathol Behav Assess 2006;29:177–190.
2003;10:125–143. 26. Rice ME, Harris GT. Comparing effect sizes in follow-up
8. Fitzpatrick L, Simpson J, Smith A. A qualitative analysis of studies: ROC area, Cohen’s d, and r. Law Hum Behav
mindfulness-based cognitive therapy (MBCT) in Parkin- 2005;29:615–620.
son’s disease. Psychol Psychother 2010;83:179–192. 27. Mutz M, Muller J. Mental health benefits of outdoor ad-
9. Hoogerwerf AEW, Bol Y, Lobbestael J, et al. Mindfulness- ventures: Results from two pilot studies. J Adolesc 2016;
based cognitive therapy for severely fatigued multiple 49:105–114.
sclerosis patients: A waiting list controlled study. J Rehabil 28. Earles JL, Vernon LL, Yetz JP. Equine-assisted therapy for
Med 2017;49:497–504. anxiety and posttraumatic stress symptoms. J Trauma
10. Kabat-Zinn J. Mindfulness. Mindfulness 2015;6:1481– Stress 2015;28:149–152.
1483. 29. Kearney DJ, Malte CA, McManus C, et al. Loving-
11. Brown KW, Ryan RM. The benefits of being present: kindness meditation for posttraumatic stress disorder: A
Mindfulness and its role in psychological well-being. J Pers pilot study. J Trauma Stress 2013;26:426–434.
Soc Psychol 2003;84:822–848. 30. de Bruin EI, van der Zwan JE, Bogels SM. A RCT com-
12. Gu J, Strauss C, Bond R, et al. How do mindfulness-based paring daily mindfulness meditations, biofeedback exer-
cognitive therapy and mindfulness-based stress reduction cises, and daily physical exercise on attention control,
improve mental health and wellbeing? A systematic review executive functioning, mindful awareness, self-compassion,
and meta-analysis of mediation studies. Clin Psychol Rev and worrying in stressed young adults. Mindfulness 2016;7:
2015;37:1–12. 1182–1192.
13. Michalak J, Heidenreich T, Meibert P, et al. Mindfulness 31. Caldwell K, Adams M, Quin RH, et al. Pilates, mindfulness
predicts relapse/recurrence in major depressive disorder and somatic education. J Dance Somat Pract 2013;5:141–153.
REVIEW OF NONMINDFULNESS-BASED INTERVENTIONS 15

32. Chavooshi B, Mohammadkhani P, Dolatshahee B. Efficacy 47. Goldin P, Ziv M, Jazaieri H, et al. Randomized controlled
of intensive short-term dynamic psychotherapy for medi- trial of mindfulness-based stress reduction versus aerobic
cally unexplained pain: A pilot three-armed randomized exercise: Effects on the self-referential brain network in
controlled trial comparison with mindfulness-based stress social anxiety disorder. Front Hum Neurosci 2012;6:295.
reduction. Psychother Psychosom 2016;85:123–125. 48. Kocovski NL, Fleming JE, Hawley LL, et al. Mindfulness
33. Chavooshi B, Mohammadkhani P, Dolatshahee B. Tele- and acceptance-based group therapy versus traditional
medicine vs. in-person delivery of intensive short-term cognitive behavioral group therapy for social anxiety dis-
dynamic psychotherapy for patients with medically unex- order: A randomized controlled trial. Behav Res Ther 2013;
plained pain: A 12-month randomized, controlled trial. J 51:889–898.
Telemed Telecare 2017;23:133–141. 49. Mantzios M, Wilson JC. Making concrete construals
34. Feicht T, Wittmann M, Jose G, et al. Evaluation of a seven- mindful: A novel approach for developing mindfulness and
week web-based happiness training to improve psycho- self-compassion to assist weight loss. Psychol Health 2014;
logical well-being, reduce stress, and enhance mindfulness 29:422–441.
and flourishing: A randomized controlled occupational 50. McIndoo CC, File AA, Preddy T, et al. Mindfulness-based
health study. Evid Based Complement Alternat Med 2013; therapy and behavioral activation: A randomized controlled
2013:676953. trial with depressed college students. Behav Res Ther 2016;
35. Soer R, de Jong AB, Hofstra BL, et al. Does mindfulness 77:118–128.
improve after heart coherence training in patients with 51. Pinniger R, Brown RF, Thorsteinsson EB, et al. Argentine
Downloaded by Universitat de Barcelona CRAI from www.liebertpub.com at 07/20/19. For personal use only.

chronic musculoskeletal pain and healthy subjects? A pilot tango dance compared to mindfulness meditation and a
study. Glob Adv Health Med 2015;4:50–55. waiting-list control: A randomised trial for treating de-
36. Armstrong L, Rimes K. Mindfulness-based cognitive pression. Complement Ther Med 2012;20:377–384.
therapy for neuroticism (stress vulnerability): A pilot ran- 52. Schellekens MPJ, Tamagawa R, Labelle LE, et al.
domized study. Behav Ther 2016;47:287–298. Mindfulness-based cancer recovery (MBCR) versus sup-
37. Morone NE, Greco CM, Moore CG, et al. a mind-body portive expressive group therapy (SET) for distressed
program for older adults with chronic low back pain: A breast cancer survivors: Evaluating mindfulness and social
randomized clinical trial. JAMA Intern Med 2016;176: support as mediators. J Behav Med 2017;40:414–422.
329–337. 53. Shapiro SL, Oman D, Thoresen CE, et al. Cultivating
38. Guardino CM, Dunkel Schetter C, Bower JE, et al. Ran- mindfulness: Effects on well-being. J Clin Psychol 2008;
domised controlled pilot trial of mindfulness training for 64:840–862.
stress reduction during pregnancy. Psychol Health 2014;29: 54. Anderson T. Personalizing the Training of Attention: Pre-
334–349. dicting Effectiveness of Meditation using Traits and Abilities.
39. Lipschitz DL, Kuhn R, Kinney AY, et al. An exploratory [Masters Thesis] Toronto (Canada): Department of Psychology,
study of the effects of mind-body interventions targeting University of Toronto, 2016. https://pdfs.semanticscholar
sleep on salivary oxytocin levels in cancer survivors. Integr .org/c8d6/e3cb0e0b267a9e16dbf8633c40cdebb05242.pdf?_
Cancer Ther 2015;14:366–380. ga=2.112715719.2108367861.1559793110-1882792870
40. Mason AE, Epel ES, Kristeller J, et al. Effects of a .1559793110
mindfulness-based intervention on mindful eating, sweets 55. Fox KC, Dixon ML, Nijeboer S, et al. Functional neuro-
consumption, and fasting glucose levels in obese adults: anatomy of meditation: A review and meta-analysis of 78
Data from the SHINE randomized controlled trial. J Behav functional neuroimaging investigations. Neurosci Biobehav
Med 2016;39:201–213. Rev 2016;65:208–228.
41. Bormann JE, Oman D, Walter KH, et al. Mindful attention 56. Chesak SS, Bhagra A, Schroeder DR, et al. Enhancing
increases and mediates psychological outcomes following resilience among new nurses: Feasibility and efficacy of a
mantram repeition practice in veterans with posttraumatic pilot intervention. Ochsner J 2015;15:38–44.
stress disorder. Med Care 2014;52:S13–S18. 57. Leong K, Chan P, Grabovac A, et al. Changes in mind-
42. Caldwell K, Harrison M, Adams M, et al. Developing fulness following repetitive transcranial magnetic sti-
mindfulness in college students through movement-based mulation for mood disorders. Can J Psychiatry 2013;58:
courses: Effects on self-regulatory self-efficacy, mood, 687–691.
stress, and sleep quality. J Am Coll Health 2010;58:433–442. 58. Moore SD, Brody LR, Dierberger AE. Mindfulness and
43. Lothes J, 2nd, Hakan R, Kassab K. Aikido experience and experiential avoidance as predictors and outcomes of the
its relation to mindfulness: A two-part study. Percept Mot narrative emotional disclosure task. J Clin Psychol 2009;
Skills 2013;116:30–39. 65:971–988,
44. Mothes H, Klaperski S, Seelig H, et al. Regular aerobic 59. Potash JS, Ho AHY, Chan F, et al. Can art therapy reduce
exercise increases dispositional mindfulness in men: A death anxiety and burnout in end-of-life care workers? A
randomized controlled trial. Ment Health Phys Act 2014;7: quasi-experimental study. Int J Palliat Nurs 2014;20:233–
111–119. 240.
45. Eliassen BK, Sorlie T, Sexton J, et al. The effect of training 60. Soler J, Elices M, Franquesa A, et al. Exploring the ther-
in mindfulness and affect consciousness on the therapeutic apeutic potential of ayahuasca: Acute intake increases
environment for patients with psychoses: An explorative mindfulness-related capacities. Psychopharmacology 2016;
intervention study. Scand J Caring Sci 2016;30:391–402. 233:823–829.
46. Garland SN, Carlson LE, Stephens AJ, et al. Mindfulness- 61. Banks JB, Welhaf MS, Srour A. The protective effects of
based stress reduction compared with cognitive behavioral brief mindfulness meditation training. Conscious Cogn
therapy for the treatment of insomnia comorbid with can- 2015;33:277–285.
cer: A randomized, partially blinded, noninferiority trial. J 62. Bergen-Cico D, Possemato K, Cheon S. Examining the
Clin Oncol 2014;32:449–457. efficacy of a brief mindfulness-based stress reduction (brief
16 XIA ET AL.

MBSR) program on psychological health. J Am Coll Health sults from a 3-armed randomized controlled trial. Pain
2013;61:348–360. 2011;152:361–369.
63. Bieling PJ, Hawley LL, Bloch RT, et al. Treatment specific 75. Schonert-Reichl KA, Oberle E, Lawlor MS, et al. Enhan-
changes in decentering following mindfulness-based cog- cing cognitive and social-emotional development through a
nitive therapy versus antidepressant medication or placebo simple-to-administer mindfulness-based school program
for prevention of depressive relapse. J Consult Clin Psychol for elementary school children: A randomized controlled
2012;80:365–372. trial. Dev Psychol 2015;51:52–66.
64. Britton WB, Lepp NE, Niles HF, et al. A randomized 76. Silverstein RG, Brown ACH, Roth HD, Britton WB. Ef-
controlled pilot trial of classroom-based mindfulness fects of mindfulness training on body awareness to sexual
meditation compared to an active control condition in sixth- stimuli: Implications for female sexual dysfunction. Psy-
grade children. J Sch Psychol 2014;52:263–278. chosom Med 2011;73:817–825.
65. Chiesa A, Mandelli L, Serretti A. Mindfulness-based cog- 77. Smith BW, Shelley BM, Dalen J, et al. A pilot study com-
nitive therapy versus psycho-education for patients with paring the effects of mindfulness-based and cognitive-
major depression who did not achieve remission following behavioral stress reduction. J Altern Complement Med 2008;
antidepressant treatment: A preliminary analysis. J Altern 14:251–258.
Complement Med 2012;18:756–760. 78. Zeidan F, Johnson SK, Diamond BJ, et al. Mindfulness
66. Chiesa A, Castagner V, Andrisano C, et al. Mindfulness- meditation improves cognition: Evidence of brief mental
based cognitive therapy vs. psycho-education for patients training. Conscious Cogn 2010;19:597–605.
Downloaded by Universitat de Barcelona CRAI from www.liebertpub.com at 07/20/19. For personal use only.

with major depression who did not achieve remission fol- 79. Ross A, Thomas S. The health benefits of yoga and exer-
lowing antidepressant treatment. Psychiatry Res 2015;226: cise: A review of comparison studies. J Altern Complement
474–483. Med 2010;16:3–12.
67. Garland EL, Roberts-Lewis A, Tronnier CD, et al. Mind- 80. Burton M, Schmertz SK, Price M, et al. The relation be-
fulness-oriented recovery enhancement versus CBT for co- tween mindfulness and fear of negative evaluation over the
occurring substance dependence, traumatic stress, and course of cognitive behavioral therapy for social anxiety
psychiatric disorders: Proximal outcomes from a pragmatic disorder. J Clin Psychol 2013;69:222–228.
randomized trial. Behav Res Ther 2016;77:7–16. 81. Van Dam NT, Sheppard SC, Forsyth JP, et al. Self-
68. Goldberg SB, Wielgosz J, Dahl C, et al. Does the five facet compassion is a better predictor than mindfulness of
mindfulness questionnaire measure what we think it does? symptom severity and quality of life in mixed anxiety and
Construct validity evidence from an active controlled ran- depression. J Anxiety Disord 2011;25:123–130.
domized clinical trial. Psychol Assess 2016;28:1009–1014. 82. Soler J, Cebolla A, Feliu-Soler A, et al. Relationship between
69. Hou RJ, Wong SYS, Yip BHK et al. The effects of meditative practice and self-reported mindfulness: The
mindfulness-based stress reduction program on the mental MINDSENS composite index. PLoS One 2014;9:e86622.
health of family caregivers: A randomized controlled trial. 83. Lutz A, Jha AP, Dunne JD, et al. Investigating the phenom-
Psychother Psychosom 2014;83:45–53. enological matrix of mindfulness-related practices from a
70. Kingston J, Chadwick P, Meron D, Skinner TC. A pilot neurocognitive perspective. Am Psychol 2015;70:632–658.
randomized control trial investigating the effect of mind- 84. Levinson DB, Stoll EL, Kindy SD, et al. A mind you can
fulness practice on pain tolerance, psychological well- count on: Validating breath counting as a behavioral mea-
being, and physiological activity. J Psychosom Res 2007; sure of mindfulness. Front Psychol 2014;5:1202.
62:297–300. 85. Ahani A, Wahbeh H, Nezamfar H, et al. Quantitative
71. McClintock AS, Anderson T, Cranston S. Mindfulness change of EEG and respiration signals during mindfulness
therapy for maladaptive interpersonal dependency: A pre- meditation. J Neuroeng Rehabil 2014;11:87.
liminary randomized controlled trial. Behav Ther 2015;46:
856–868.
72. Noggle JJ, Steiner NJ, Minami T, Khalsa SBS. Benefits of
yoga for psychosocial well-being in a US high school Address correspondence to:
curriculum: A preliminary randomized controlled trial. J Tom Xia, MD
Dev Behav Pediatr 2012;33:193–201. Department of Psychiatry and Behavioral Sciences
73. Robins JL, Elswick RK Jr, Sturgill J, McCain N. The ef- Keck School of Medicine of USC
fects of tai chi on cardiovascular risk in women. Am J 1200 N, State Street CT-A7D
Health Promot 2016;30:613–622. Los Angeles, CA 90033
74. Schmidt S, Grossman P, Schwarzer B, et al. Treating fi-
bromyalgia with mindfulness-based stress reduction: Re- E-mail: Tom.Xia@med.usc.edu