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The goal of psychological and behavioral intervention is to help people live better lives. It is possible, however, that such interventions can also cause harm for select individuals. This is as true of mindfulness meditation as it is of other cognitive-behavioral and therapeutic interventions. Researchers want to learn who might be most vulnerable to adverse effects and under what circumstances. Examples of adverse effects include anxiety, depression, flashbacks, psychotic symptoms, and alterations in identity.
There is anecdotal evidence that adverse effects may be more common in intensive meditation retreats than in standard mindfulness-based interventions (MBIs). Aizik-Reebs et. Al [Behaviour Research and Therapy] used experience sampling (checking in on how participants felt at random moments) to evaluate the frequency of momentary and persistent adverse effects associated with participation in a MBI.
The researchers recruited 82 meditation-naïve Israelis (52% female; average age = 25 years) seeking stress-reduction. Prior to starting the MBI, participants were assessed on measures of mindfulness, anxiety, depression, worry, rumination, and distress tolerance.
The 21-day MBI included 3 group-based session held once per week for 90 minutes each, and 3 web-based 30-minute individual sessions. Session content included focused-attention, open monitoring, and movement meditations with encouragement for daily home practice.
Participant experience sampling was conducted several times a day over a 28-day period beginning 3.5 days before and ending 3.5 days after the MBI. During sampling, participants rated the extent of their negative emotions and cognitions. Experience samples were taken immediately after three mindfulness meditation sessions, and at random times throughout the day.
Momentary adverse effects were defined as significant (>1.96 standard deviations) deteriorations in mood during meditation compared to participant mood during normal daily activities. Sustained adverse effects were defined as significant deteriorations in mood during the 3.5 days after the MBI relative to the 3.5 days prior to the MBI.
The results showed 87% of participants experienced at least one momentary adverse effect during the three sampled meditation sessions, with 42% having them during two and 28% in all three sessions. The most common adverse events were momentary increases in anxiety (70% of adverse events), rumination (29%), sadness (22%), and depressed mood (17%).
Twenty-five percent of the participants showed a sustained adverse effect (poorer mood after the MBI than before). The most common sustained adverse effects were increases in worry (9%), decreases in happiness (7%), and increases in rumination (6%). Momentary adverse effects and measures of pre-intervention emotional vulnerability were uncorrelated with sustained adverse effects.
The study shows moments of anxiety, worry, and negative mood are commonplace in novice meditators during early stages of a meditation program, but these momentary experiences are not predictive of sustained adverse effects. About a quarter of meditation-naïve participants experienced poorer mood after completing the MBI program than before.
It is possible that increases in negative mood are due to facing previously avoided problems, transitioning to new coping strategies, increased awareness of feelings, or a genuine deterioration in functioning. The study is limited by a brief follow-up period and the absence of a control group.
Aizik-Reebs, A., Shoham, A., & Bernstein, A. (2021). First, do no harm: An intensive experience sampling study of adverse effects to mindfulness training. Behaviour Research and Therapy.
Link to study
Social anxiety disorder is a diagnosis of unreasonable fear of embarrassment in social situations. People with social anxiety disorder often avoid social situations, thereby limiting the quality of their lives. Cognitive-Behavioral Therapy (CBT) uses cognitive reappraisal to reduce social anxiety through questioning irrational beliefs about feared outcomes. Mindfulness-Based Stress Reduction (MBSR) stresses the acceptance of thoughts, rather than altering them.
While CBT and MBSR are both effective in treating social anxiety disorder, it is not clear whether their benefits are due to unique or shared therapeutic elements. Goldin et al. [JAMA Psychiatry] conducted a randomized controlled trial of CBT and MBSR to test the efficacy of each program on anxiety among people with social anxiety disorder, and tested the neural activity associated with each program.
The researchers randomly assigned 108 unmedicated generalized social anxiety disorder patients (56% female; average age=33 years; 44% White; 39% Asian-American, 9% Latino, 9% Other) to CBT, MBSR, or a waitlist control. Patients completed self-report measures of anxiety symptoms at baseline, posttreatment, and one year follow-up, and an fMRI task at baseline and posttreatment.
CBT and MBSR were delivered in 12 weekly 2.5-hour group sessions. CBT included cognitive restructuring, exposure, and relapse prevention. MBSR used a standard 8-week protocol with four additional weekly sessions substituting for the all-day retreat.
Before undergoing functional brain imaging, participants wrote down scenarios for the social situations that personally caused them anxiety along with the negative self-beliefs associated with those scenarios. Participants then imagined the feared social situations and associated self-beliefs, and either reacted to, reappraised, or accepted them while undergoing imaging.
Brain regions selected for analysis were previously associated with cognitive restructuring and attentional regulation (e.g., prefrontal and anterior cingulate cortices).
Previously published results from this study showed CBT and MBSR both reduced social anxiety symptoms significantly more than waitlist controls at post-treatment and one-year follow-up. The effects of CBT and MBSR were equivalent in size.
CBT and MBSR groups showed similar significant reductions in negative emotions during reacting, reappraising, and accepting trials from pre- to post-testing (partial η2 range=0.38-0.53). These changes were significantly greater than changes in the control group.
Both treatment groups showed increased brain activation in regions of interest compared to controls, and these changes were similar across CBT and MBSR groups.
The study shows CBT and MBSR are similarly effective in reducing social anxiety compared to a wait-list control, and that improvement is maintained at one-year follow-up. It suggests that, despite contrasting models of therapeutic change, CBT and MBSR have overlapping effects on brain activity. Despite their application of differing strategies, they both refine awareness, weaken avoidant behavior, and decrease the influence of negative self-beliefs. Acceptance and reappraisal strategies may involve brain regions that share substantial overlap.
The study is limited by excluding other brain regions previously associated with MBSR that may differ from CBT.
Goldin, P. R., Thurston, M., Allende, S., Moodie, C., Dixon, M. L., Heimberg, R. G., & Gross, J. J. (2021). Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial. JAMA Psychiatry.
An epidemic of obesity has been reported in the United States. Over 40% of Americans are classified as overweight and at elevated risk for diabetes, heart disease, and stroke. Obesity-associated medical costs are estimated at $147 billion yearly. Cognitive-behavioral programs are used in an attempt to support weight loss, but often fail because cognitive control over emotionally rewarding eating is difficult to sustain.
Mindful attention to eating, however, may reduce binge eating by lowering our expectations of just how rewarding eating a craved food will be. Taylor et al. [Journal of Behavioral Addictions] conducted two studies to test if mindfulness alters expectations of the reward of eating, and whether such changes result in decreased binge eating behavior.
In the first study, 64 overweight women (average age=53 years; 92% Caucasian; average BMI=33) participated in an 8-week app-based mindful eating program. The mindful eating app contained 28 self-paced sequential modules introducing mindfulness in brief video format. Modules were designed to help participants become mindful of eating triggers and learn mindful eating skills.
The app included a tool that participants used when they experienced cravings to binge eat. The tool had them rate their craving intensity, then imagine themselves eating the desired food and how that would make them feel, then rate their subsequent craving intensity, and finally decide whether or not to yield to the craving. If participants decided to go ahead and binge eat, they then rated how much food they ate and the level of contentment they felt after mindfully attending to their body, thoughts, and emotions.
The tool intended to help participants become aware of discrepancies between how they expected to feel and how they actually felt after yielding to cravings, and to ultimately update their expectancies in accordance with this realization.
Participants completed several eating-related self-report measures before and after the 8-week intervention. Results showed significant reductions in food craving (Cohen’s d=1.25) and stress-based (d=1.35) and reward-based (d=1.19) eating after the intervention. Decreases in the expected reward value of food were significantly associated with increased use of the app-based craving tool. The more frequently the participants used the tool, the less they binge ate.
The authors conducted a second naturalistic community-based study examining data from a pool of 1,119 mindfulness app users. The pool was subdivided into a “low use” group of 1,044 participants who used the craving tool <10 times (females=78%; average age=45 years) and a “high use” group of 75 participants who used the craving tool ≥10 times (females=79%; average age=49 years).
Results from the second study showed the more participants used the craving tool, the smaller their anticipated rewards from eating craved foods. Unlike the first study, binge eating did not decrease with increased tool use. A post-hoc analysis of the low use group showed binge eating increased for participants who used the craving tool 1-3 times and decreased for those using it 5 or more times.
These two studies showed a mindful eating app reduced the frequency and amount of binge eating in an experimental setting, but not in a naturalistic community setting. More use of the mindful craving tool resulted in lower reward expectancies about the benefit of eating, and to less binge eating for participants who used the tool at least five times. The study is limited by the absence of a control group.
Taylor, V. A., Moseley, I., Sun, S., Smith, R., Roy, A., Ludwig, V. U., & Brewer, J. A. (2021). Awareness drives changes in reward value which predict eating behavior change: Probing reinforcement learning using experience sampling from mobile mindfulness training for maladaptive eating. Journal of Behavioral Addictions.
How does mindfulness reduce the experience of pain? One theory has it that focusing mindfully on present-moment sensory experience reduces the influence of held beliefs. For example, past experiences with pain shape expectations about what pain will be like in the future.
Using a pain conditioning experiment, Vencatachellum et al. [European Journal of Pain] tested the effect of inducing mindfulness compared to pain-suppression strategies on pain expectations.
The researchers enrolled 68 healthy meditation-naive participants (50% female; average age=27 years) from three European countries in a laboratory study. All participants first underwent sensory conditioning that paired a computer-presented visual cue with a heat stimulus delivered a few seconds later to their forearm. The heat stimulus was calibrated to each participant to induce low, moderate, or high levels of heat-induced pain.
Color cues were consistently paired with subsequent pain stimuli so that the colors became associated with an expected degree of pain. As such, participants now learned what to expect. Participants rated their anxiety and pain intensity and unpleasantness on each trial.
After the cue conditioning, participants were randomly assigned to receive 10 minutes of audio training in either mindfully attending to pain or suppressing pain. Participants were then exposed to the previously conditioned color cues along with a novel color cue, each followed by a moderate pain stimulus. The novel color was added because it was not conditioned with pain and so served as comparison to the conditioned colors. Participants again rated their anxiety and pain.
The researchers then assessed whether the moderate pain stimulus was rated as more painful following the high-pain color cue, or less painful following the low-pain color cue than after the unconditioned color cue.
Results showed that after the low-pain cue, the suppression group judged the moderate pain stimulus as less-than-moderate. The mindfulness group judged it, accurately, as moderate. No group difference was found for judgements about the high-pain cue.
The study findings offered partial support for a theory proposing that mindfulness reduces the influence of learned expectancies on future pain judgments, but only when expectancies signal a lower level of pain. The study is limited by the brevity of its mindfulness induction and the absence of a control group instructed merely to rest during the pain task.
Vencatachellum, S., Meulen, M. van der, Ryckeghem, D. M. L. V., Damme, S. V., & Vögele, C. (2021). Brief mindfulness training can mitigate the influence of prior expectations on pain perception. European Journal of Pain.
Many psychotherapeutic interventions are available to treat pain. Mindfulness-Based Stress Reduction, Cognitive Therapy, and Behavior Therapy are shown to be effective in improving pain-related outcomes among patients with chronic pain. However, little is known about whether one of these treatments is superior.
Burns et al. [Pain] conducted a randomized controlled trial to compare the effect of these three interventions relative to each other as well as to a treatment-as-usual control group on pain-related outcomes. Relative efficacy, rate of benefit gained, and persistence of effect at follow up were compared across groups.
The researchers randomly assigned 521 participants (51% Black; 58% female; average age = 53 years; average duration of pain = 12 years) with chronic lower back pain to Mindfulness-Based Stress Reduction (MBSR), Cognitive Therapy, Behavioral Therapy, or a treatment-as-usual control. Participants had significant daily back pain and related impairments in activities of daily living for at least six-months.
All treatments were manualized and delivered in eight weekly 90-minute individual therapy sessions by clinical psychologists with prior experience in psychosocial interventions for pain. Participants were assessed on pain interference and intensity and pain-related outcomes of mood, sleep disturbance, and physical functioning at study baseline, weekly during the treatment period, and at 6-month follow-up.
MBSR participants engaged in body scan, sitting, and gentle movement meditations, and focused on cultivating mindfulness in activities of daily life. Cognitive Therapy participants learned to identify, evaluate, and correct automatic pain-related thoughts. Behavior Therapy participants learned how to set and track realistic daily activity goals aimed at graded increases in activities such as walking and standing, as well as increased engagement in pleasure-generating activities.
Treatment-as-usual was whatever standard care participants received before the start of the study, usually pain medication and social support from a medical team.
The results showed that all three therapy groups were superior to the control group. The range of effect sizes for treatment groups compared to the control group were of small size for pain interference and physical functioning (Cohen’s d=0.21-0.26) and up to medium size for pain intensity (d=0.30-0.48), mood (d=0.26-0.53), and sleep disturbance (d=0.26-0.61). This superiority over the control group was statistically equivalent across the therapy groups, and no one therapy (MBSR, CT, BT) showed superiority over any other therapy group.
All three therapy groups diverged from the control group by week six of therapy on all measures, thus shedding light on an important time signal of change. All therapy group gains over the control group were maintained at six-month follow-up. Again, no single treatment group was significantly superior to any other treatment group at follow-up.
The study shows that three different psychotherapeutic interventions lend benefit on pain-related outcomes beyond that of standard care practices for patients with long-term pain. Findings uncover that multiple therapies can aid in improving pain outcomes, giving patients the option to select a therapy they prefer.
The study is limited given that the MBSR group did not receive the full curriculum, and there was no indication of whether therapists delivering MBSR had adequate training in the program and a personal meditation practice.
Burns, J. W., Jensen, M. P., Thorn, B. E., Lillis, T. A., Carmody, J., Newman, A. K., & Keefe, F. (2021). Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: A single-blind randomized controlled trial. Pain.
Perimenopause, the multiyear transition from regular menses to their complete cessation, places women at increased risk for depression, with 45-68% of perimenopausal women reporting depressive symptoms.
Erratic levels of the reproductive hormone estradiol play a role in this increased vulnerability for depression, but not all women have moods that fluctuate with estradiol levels. Women with wider hormonal-related mood fluctuations are more vulnerable to stress and more likely to experience depressive symptoms.
Gordon et al. [Psychoneuroendocrinology] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on women’s perimenopausal depressive symptoms, and then explored whether the program might prove especially helpful for women with elevated hormonal-related mood fluctuations.
The researchers randomly assigned 104 mediation-naïve Canadian healthy perimenopausal women (average age = 49 years; 89% Caucasian; early menopause = 69%, late menopause = 31%) to MBSR or a wait-list control. MBSR was taught by experienced MBSR teachers and delivered in 2.5-hour group sessions over an 8-week period, with a 7-hour silent retreat in the sixth week.
Baseline urine estradiol levels and daily moods were assessed over a period of 30-50 days prior to randomization, and the researchers calculated a standardized mood sensitivity to estradial changes based on these data. Self-report measures, histories of trauma, and recent stressful events were also assessed at baseline.
Depressive symptoms were assessed at baseline, immediately after intervention, and every two weeks during a 6-month follow-up. Perceived stress, anxiety, mindfulness, resilience, and sleep quality were assessed at baseline, immediately after intervention, and at 2-, 4-, and 6-month follow-up. Participants with high levels of self-reported depressive symptoms were assessed for major depression in structured clinical interviews.
The results showed that the MBSR group showed significantly greater reductions in depressive symptoms (d = -0.34), perceived stress (d = -0.55), and anxiety (d = -0.53), and greater increases in mindfulness (d = -0.46) and resilience (d = -0.30) than controls at postintervention and throughout follow-up.
The subgroup of participants displaying elevated mood sensitivity to estradiol benefited most from MBSR. Women in early perimenopause benefitted more than those in late perimenopause from MBSR, and decreases in depressive symptoms were dose-dependent on home meditation practice.
The study shows MBSR is more effective in reducing depressive symptoms in perimenopausal women than a wait-list control. Women early in menopause and women sensitive to hormonal-related mood changes appear to gain the most benefit from MBSR practices.
The study is limited by the absence of an active comparison group, support group, or clinical monitoring program that might improve depressive symptoms in a similar fashion.
Gordon, J. L., Halleran, M., Beshai, S., Eisenlohr-Moul, T. A., Frederick, J., & Campbell, T. S. (2021). Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial. Psychoneuroendocrinology.
College can be demanding, and up to one-third of college students report feeling highly stressed. High stress levels can be a significant problem since a third of all college students report current or past mood, anxiety, or substance use disorders which can be retriggered or worsened by stress.
Mindfulness training can effectively reduce stress, but many students who enroll in mindfulness programs drop out before completion. Virtual reality (VR) technology has shown promise to improve learning, and may perhaps increase treatment adherence.
Mondrego-Alarcón et al. [Behaviour Research and Therapy] compared the relative efficacy of mindfulness versus relaxation training in reducing college student stress, and explored whether VR added to the mindfulness program reduces attrition.
The researchers randomly assigned 280 Spanish college students (79% female; average age = 22 years) to a standard mindfulness program, a VR-enhanced mindfulness program, or an active relaxation control. All groups met in person once weekly for six weeks. The mindfulness programs emphasized mindfulness and self-compassion using the body scan, and sitting, walking, movement, and self-compassion meditations.
The standard mindfulness condition met in 90-minute group sessions, while the VR-enhanced mindfulness condition met in 75-minute group sessions coupled with brief individual VR-guided meditations.
The body scan VR-meditation included a visual simulation of the human body which successively highlighted body parts as participants attended to those parts. Another VR meditation involved a virtual nature walk with participants mindfully observing their thoughts.
The relaxation control group utilized progressive muscle relaxation and visual imagery but did not use VR. All participants were assessed at baseline, post-treatment, and 6-month follow-up on the primary self-report measure of perceived stress as well as on the secondary outcomes.
The results show that, relative to the relaxation group, mindfulness (d=-0.72) and VR-enhanced mindfulness (d=-0.59) groups showed less perceived stress after intervention. This superiority remained at 6-month follow-up. The effect was dose dependent for mindfulness—the more sessions participants attended, the less their stress—but not for relaxation. Increases in mindfulness and self-compassion both contributed to decreased stress.
At post-treatment, the standard mindfulness group also showed significantly greater improvements on the secondary outcome measures of trait anxiety (d = -.90), emotional suppression (d = -0.71), mindfulness (d = 1.01), and self-compassion (d = .1.10) than the relaxation group.
These relative improvements persisted at 6-month follow-up and were joined by additional improvements in state anxiety (d = -1.37), affect balance (d = 1.02), academic engagement (d = 1.14) and burnout (d = -1.60). The VR-enhanced mindfulness group performed similarly on these measures but did not outperform the standard mindfulness group.
VR-enhanced participants had significantly better attendance than standard mindfulness participants, who in turn had significantly better attendance than relaxation participants. Ninety-six percent of the VR-enhanced group attended at least half of all sessions, compared with 83% of the standard mindfulness and 70% of the relaxation group.
The study shows mindfulness training to be superior to relaxation training in reducing stress in college students. Adding VR correlates with improved attendance in this younger sample, but did not yield superior efficacy on stress reduction.
The study is limited by its reliance on self-report measures, and inability to determine whether any novel activity for young adults like VR would increase motivation to attend a behavioral intervention.
Modrego-Alarcón, M., López-del-Hoyo, Y., García-Campayo, J., Pérez-Aranda, A., Navarro-Gil, M., Beltrán-Ruiz, M., Morillo, H., Delgado-Suarez, I., Oliván-Arévalo, R., & Montero-Marin, J. (2021). Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behaviour Research and Therapy.
A common worry among older adults is cognitive decline. Older adults may worry about possible cognitive decline even when standardized tests fail to reveal signs of cognitive deficits. Adults with subjective cognitive decline are often anxious about their perceived loss of ability and emotionally reactive to minor acts of forgetfulness.
Marchant et al. [Psychotherapy and Psychosomatics] conducted a randomized controlled study to test the effect of a mindfulness-based intervention on anxiety in older adults with subjective cognitive decline compared to health self-management program.
The researchers recruited 147 participants (average age=73 years; 65% female) from memory clinics located in four European cities. Participants were self-referred or referred by physicians to the clinics because of their subjective memory complaints, but performed normally on standardized cognitive tests. Clinic patients with mild cognitive impairment, dementia, depression and anxiety disorders were excluded from the study.
Participants were randomly assigned to a Caring Mindfulness Approach for Seniors (CMBAS) program, or a health self-management program. CMBAS was modeled after the Mindfulness Based Stress Reduction program, and held in groups for 2-hours per week for 8 weeks. The program was tailored to the needs of older adults and emphasized compassion and lovingkindness meditation.
The health self-management program had the same structure and format as CMBAS, and emphasized sleep hygiene, stress management, exercise, diet, communication, memory, and action plans for improving health. Participants completed the State-Trait Anxiety Inventory and the Geriatric Depression Scale at baseline, post-intervention, and 6-month follow-up.
The results showed significant reductions at post-intervention in trait anxiety for both CMBAS (d=0.31) and health self-management (d=0.26) groups without any statistically significant superiority found for CMBAS. The reductions in trait anxiety were maintained at 6-month follow-up for both groups.
The CMBAS group had a significant decline in state-anxiety at post-intervention, but this was not significantly different from the smaller decline in the health self-management group.
Approximately equal percentages of CMBAS (15%) and health self-management (14%) participants experienced clinically meaningful anxiety improvements. Neither intervention reduced depressive symptoms, but depressive symptoms were already low at baseline.
The multinational clinical trial showed an adapted mindfulness or health self-management intervention reduced trait anxiety in older adults with subjective cognitive decline immediately after intervention and at 6-months after intervention end.
The study is limited by its lack of a passive control group to determine if mere monitoring over time by the study team tends to reduce anxiety among people concerned over cognitive decline. The findings cannot be generalized to those with anxiety disorders as those eligible had only subclinical symptoms of anxiety.
Marchant, N. L., Barnhofer, T., Coueron, R.,...Molinuevo, J. L. (2021). Effects of a Mindfulness-Based Intervention versus Health Self-Management on Subclinical Anxiety in Older Adults with Subjective Cognitive Decline: The SCD-Well Randomized Superiority Trial. Psychotherapy and Psychosomatics.
Mindfulness training often results in mood benefits given that practitioners learn to experience discomfort without reactivity and cultivate positive emotions. However, little is known how mindfulness training affects shifts in daily positive and negative emotions.
People differ in how much their emotions vary over the course of a day (affect variability), how easily their emotions are aroused (affect instability), and how persistent emotions are once they are once aroused (affect inertia). Higher levels of negative emotional variability, instability, and inertia are observed in people with various mental health disorders. By contrast, people who are more mindful generally experience less negative affect variability, instability, and inertia.
Keng et al. [Mindfulness] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on daily emotional shifts in a randomized study compared to an active control.
The researchers randomly assigned a non-clinical sample of 158 adult ethnic Chinese Singaporeans (average age=29 years; 59% female) to either MBSR or a music therapy-based stress reduction program. MBSR was delivered using the standard 8-week group protocol that included a half-day meditation retreat.
The music therapy control was matched to MBSR in terms of time duration and retreat, structure, and social support. Music therapy included supportive music and imagery, performance, receptive listening, composition, and improvisation.
Participants reported on their emotions 12 times daily for 3 days prior to and 3 days after the interventions in response to smartphone-delivered prompts. Prompts were issued an average of every half-hour between 9AM and 5PM. At each prompt, participants rated their experience of 17 different emotions.
Affect variability was measured using the standard deviation of ratings, inertia by rating intercorrelations between time points, and instability by the average squared differences between successive time points. Participants also completed a questionnaire of self-reported emotional regulation difficulties before and after the intervention.
The results showed that the MBSR group significantly decreased the variability and instability of negative emotions with a small-to-medium effect size, and significantly decreased emotional regulation difficulties relative to the music therapy group. MBSR showed significantly greater decreases in variability for anger, fear, guilt/shame, and sadness, and significantly greater decreases in instability for anger, fear guilt/shame, sadness, worry, frustration, and disgust.
MBSR participants were significantly less likely than those in music therapy to experience any increases in negative emotion larger than two standard deviations in magnitude. There were no differences by group on the average intensity of negative emotions, negative affect inertia, or any of the positive emotion variables.
The study shows MBSR, relative to music therapy, reduces the volatility of daily negative emotions and improves self-report of emotional regulation without necessarily changing the intensity of participants’ average daily positive or negative moods.
These findings are in accord with the common training principle that mindfulness does not necessarily stamp out negative emotions, but helps one experience them with diminished reactivity.
Keng, S.-L., Tong, E. M. W., Yan, E. T. L., Ebstein, R. P., & Lai, P.-S. (2021). Effects of Mindfulness-Based Stress Reduction on Affect Dynamics: A Randomized Controlled Trial. Mindfulness.
Mindfulness requires cognitive effort and so practice places demands on a meditator’s attention. Many psychological disorders include impairment in attention as a symptom, and patients with attentional impairment may find mindfulness practice too frustrating to sustain. Medications that improve attentional focus may help mindfulness practitioners gain more from their practice.
Modafinil is a medication that improves attention in patients with daytime sleepiness due to problems sleeping. Its psychopharmacologic effects mirror some of the attentional improvements seen in mindfulness training.
Thomas et al. [Journal of Psychopharmacology] tested the effects of modafinil on self-reported state mindfulness, mind wandering, and vigilance among participants practicing mindfulness or relaxation training.
The researchers randomly assigned 80 healthy meditation-naïve participants (average age=25 years; 50% male) to one of four groups: modafinil + mindfulness, modafinil + relaxation, placebo + mindfulness, and placebo + relaxation. Participants were blinded to drug and practice type. On the first day of an eight-day intervention, participants received 200mg of modafinil or a placebo pill and trained in mindfulness or relaxation.
Participants completed assessments immediately before and two hours after medication delivery, and again immediately after initial meditation or relaxation on a variety of measures.
Over the next six days, participants engaged in daily home practice of mindfulness or relaxation techniques, and were then reassessed on the eighth day. Outcome measures included state and trait mindfulness, mood, mind-wandering, heart rate variability, and sustained attention.
Mindfulness and relaxation trainings were delivered as 10-minute audio recordings that contained brief instruction and practice. Mindfulness instructions involved focused attention on the breath.
Relaxation instructions involved abdominal breathing and intentional muscle relaxation. Both sets of instructions emphasized returning to task if one’s mind wandered.
Post-training mind-wandering was assessed by having participants practice either mindfulness or relaxation for 16 minutes, and click on a keyboard mouse whenever their minds wandered. Sustained attention was measured by response times to stimuli randomly presented on a computer screen. This task is known to be sensitive to both mindfulness training and modafinil.
Results from the single day experiment showed modafinil improved state mindfulness before (d=0.34) and after both mindfulness and relaxation training (d=0.45), and to a similar extent by group. Modafinil improved positive mood before (d=0.54) and after the trainings (d=0.60), and to a similar extent by group.
Heart rate variability (a sign of increased parasympathetic activity) increased in the mindfulness group but not the relaxation group (d=0.52). Modafinil significantly improved sustained attention in both groups (partial η2=0.07). There were no drug or group effects on subjective mind-wandering.
After eight days of home meditation or relaxation practice, all groups significantly improved on state mindfulness. Groups who received modafinil on the first day of the intervention showed significantly more weekly home practice (average = 55 mins) than those who received placebo (average = 36 mins).
The study shows that modafinil improves state mindfulness, sustained attention, and positive mood in a single-day experiment. When given at baseline, it increases practice effort over the course of about a week. Mindfulness training increases heart rate variability more than relaxation training, but there were no differences between the trainings on state mindfulness.
The absence of any difference between the groups on state mindfulness may be due to similarities between the trainings, as both involved breathing and instructions to maintain focus. The study is limited by the brevity of its trainings, and lack of emphasis on non-judgmental awareness in the mindfulness group.
Thomas, E. M., Freeman, T. P., Poplutz, P., Howden, K., Hindocha, C., Bloomfield, M., & Kamboj, S. K. (2021). Stimulating meditation: A pre-registered randomised controlled experiment combining a single dose of the cognitive enhancer, modafinil, with brief mindfulness training. Journal of Psychopharmacology.
[Link to study]
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