News

Contemplative practices such as mindfulness, lovingkindness, and self-compassion may have different effects on humans, and these differences may become obscured when they are combined in interventions. Certain practices may prove more effective than others in remedying specific types of mental and physical health problems.

Petzold et al. [Scientific Reports] compared the immediate mental effects of using two different types of contemplative practice apps: a mindfulness meditation app and a social-emotional app. 

The researchers randomly assigned 212 German-speaking Berlin residents (average age = 44 years; 73% Female) to use either a mindfulness meditation app or a social-emotional Affect Dyad app. Participants in both conditions participated in 2.5-hour orientation webinars and proceeded to 10 weeks of app use. Participants used the apps six days a week, and on the seventh day of each week participated in 2-hour on-line group coaching sessions.

The mindfulness app contained 12-minute guided breath-focused, sensory, and open monitoring meditations. Mindfulness coaching sessions emphasized bodily and sensory awareness, dealing with difficult emotions, and cultivating an attitude of dignity and respect towards oneself. 

The Affect Dyad app paired participants with another participant to discuss two recent events—one that elicited difficult emotions and one that elicited gratitude—and describe how those emotions affected their bodies. Participants spoke for 6 minutes while their partner listened without interruption, and then switched roles.

Affect Dyad coaching sessions emphasized social connectedness, non-judgmental listening, bodily awareness, dealing with difficult emotions, and cultivating care and gratitude.

Participants rated their thoughts and affect prior to and after daily app sessions. Thoughts were rated for temporality (about past, present, or future), social orientation (about self or other) and emotional valence (positive or negative). Affect was rated for emotional valence and intensity. The data enabled researchers to compare immediate changes in thought and affect resulting from app use and analyze group differences in these changes. These were immediate mental changes due to engaging with the app and not long-term results from engaging in these interventions over a period of 10 weeks. There were no significant between- or within-group long-term changes in thought and affect.

The results showed that mindfulness meditation app group significantly reduced future-oriented, negative, and other-oriented thoughts while increasing positive affect and affect intensity.

In contrast, the Affect Dyad app group significantly reduced future-oriented thoughts, increased past-oriented and other-oriented thoughts, and raised positive affect and affect intensity.

Self-oriented thoughts increased for both groups but did so significantly more for the Affect Dyad group compared to the mindfulness group. 

The researchers interpreted these results as showing that mindfulness meditation app reduces thinking and improves mood through “calming the mind,” whereas the Affect Dyad app increases past-, self-, and other-directed thoughts and improves mood through enhancing social connection and caring. While both apps showed substantial immediate short-term effects, it is unclear whether they yield meaningful long-term effects.

Smartphone apps are becoming an increasingly important way people engage with contemplative practices—meditation apps now have 185 million users—and this study’s combining of daily app practice with weekly on-line coaching seems one promising way to scale-up engagement with these practices.

Reference:

Petzold, P., Silveira, S., Godara, M., Matthaeus, H., & Singer, T. (2023). A randomized trial on differential changes in thought and affect after mindfulness versus dyadic practice indicates phenomenological fingerprints of app-based interventions. Scientific Reports. 

Link to study

Inadequate diet and high stress during pregnancy are risk factors for having low birthweight infants and experiencing poorer cognitive and social development in early childhood. Improving dietary intake and reducing maternal stress during pregnancy may yield long-term benefits for their children’s later development.

Crovetto et al. [JAMA Network Open] conducted a study to test the long-term effects of Mindfulness-Based Stress Reduction (MBSR) or a Mediterranean diet intervention compared to treatment as usual for pregnant women on toddler development.

The study recruited 1,221 Barcelonian mid-gestation pregnant women who were assessed as being at high-risk for delivering low birthweight infants. The prospective mothers were randomly assigned to usual treatment alone, usual treatment plus MBSR, or usual treatment plus a Mediterranean diet. MBSR consisted of eight 2.5 hour weekly group sessions, a full day retreat, and home practice. It used a standard MBSR syllabus that included a specialized focus on maternal yoga and mothers’ relationships with their fetuses.

The Mediterranean diet intervention consisted of monthly 30-minute assessments and 1-hour group sessions conducted by trained nutritionists. Participants were provided with 2 liters of extra virgin olive oil and 450 grams of walnuts each month, along with weekly suggested shopping lists, detailed meal plans, and menus. The usual care group received pregnancy care according to institutional protocols.

Adherence was 72% in the Mediterranean diet group (based on a ≥ 3 point pre-post improvement on a 17 item dietary adherence questionnaire) and 64% in the MBSR group (based on attendance of ≥6 group sessions).

All participants completed dietary questionnaires, and a randomly selected subset (47%) of the sample underwent blood and urine draws to assess biomarkers of walnut and olive oil consumption at both baseline and the final visit. Participants were also assessed on measures of stress, anxiety, wellbeing, and mindfulness. A separate randomly selected subset (27%) of the sample had 24-hour measures of urinary stress hormones at both baseline and the final visit.

In a separately published study, MBSR mothers (16%) and Mediterranean diet mothers (15%) were less likely to deliver low birthweight infants than usual care mothers (22%). In the present study, 626 toddlers (53% male; average age = 25 months) from the women in that original study were assessed on cognitive, language, motor, and social-emotional development and adaptive behavior using the Bayley Scales of Infant and Toddler Development. The number of toddlers is lower than the study sample of mothers, mainly due to difficulties in locating mothers for follow-up or obtaining their consent.

The results showed that Mediterranean diet toddlers had significantly higher Bayley cognitive and social-emotional scores than usual care toddlers. MBSR toddlers had significantly higher Bayley social-emotional scores than usual care toddlers, although the effect size was small.

Mediterranean diet adherence (regardless of group) was significantly positively associated with Bayley cognitive and language scores. Higher levels of consumption of foods containing docosahexaenoic acid was associated with significantly better language scores, while higher consumption of foods containing trans fats was inversely associated with social-emotional scores and language scores.

Maternal levels of stress and anxiety during pregnancy, irrespective of the group, showed significant negative associations with all five Bayley scales. Several FFMQ subscales (especially Describing and Acting with Awareness) showed significant positive associations with multiple Bayley scales.

The study shows improved maternal diet and MBSR during pregnancy have positive long-term effects on early childhood development for mothers at risk of having low birthweight babies. Adding nutritional support and mindfulness meditation to maternity care-as-usual for high-risk mothers could have a significant impact on the lives of children, their families, and on the social competencies gained by society in general. 

Reference:

Crovetto, F., Nakaki, A., Arranz, A.,… Gratacós, E. (2023). Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment: A Prespecified Analysis of the IMPACT BCN Randomized Clinical Trial. JAMA Network Open, 6(8), e2330255. 

Link to study

Stress can affect people with Type 2 Diabetes by raising stress-associated cortisol levels that stimulate greater production of blood sugar (glucose). Aerobic exercise can improve health in persons with diabetes by improving insulin sensitivity, lowering glycated hemoglobin (HbA1c) levels, and promoting cardiovascular fitness. Intentional slow breathing and mindfulness meditation may offer additional benefit to persons with diabetes by reducing stress-related cortisol levels that show an association with glucose levels. 

Obaya et al. [Frontiers of Physiology] conducted a study to compare the effects of aerobics exercise alone versus aerobics exercise combined with intentional slow breathing and mindfulness meditation on cortisol and glucose levels in women with Type 2 Diabetes.

The researchers randomly assigned 58 Middle-Eastern women (average age = 46 years) to either an aerobics training group (AT) or an aerobics training group that also included slow, deep breathing and mindfulness meditation (AT+DMM). All participants met the following criteria: 1) diagnosed with Type 2 Diabetes, 2) experiencing moderate-to-high stress levels, and 3) engaging in low levels of physical activity. Both groups met for three sessions per week for six weeks with sessions lasting 40 minutes for the AT group and 60 minutes for the AT+DMM group. 

Aerobics training involved using a treadmill at an intensity of 60-75% of each participant’s maximum heart rate. Following aerobics training, the AT+DMM group added 10 minutes of slow and deep abdominal breathing, followed by 10 minutes of mindfulness meditation.

During mindfulness practice, participants sat upright while attending to their breath and listening to relaxing music. Blood draws were collected at pre- and post-intervention at 8:00AM to quantify serum cortisol and fasting blood glucose.

The results revealed that both study groups significantly reduced their blood serum cortisol and fasting blood glucose after the intervention. The AT+DMM group had significantly larger decreases in blood serum cortisol (d=0.69) and fasting blood glucose (d=0.94) than the AT group, achieving a 30% decrease in serum cortisol and a 15% reduction in fasting blood glucose compared to baseline levels.

The study shows that intentional slow breathing and mindfulness meditation adds to the benefits of aerobic exercise in reducing cortisol and glucose levels in a sample of stressed women with Type 2 Diabetes. These findings suggests that slow breathing and breath-focused meditation may be a useful adjunctive treatment in managing high blood sugar when combined with exercise for people experiencing heightened levels of stress.

The study is limited by its not exploring the differential effects of slow breathing and meditation and by the brief duration of the intervention which prevented it from yielding interpretable change in HbA1c given that HbA1c provides a measure of the average blood sugar level over the preceding three months.

Reference:

Obaya, H. E., Abdeen, H. A., Salem, A. A., Shehata, M. A., Aldhahi, M. I., Muka, T., Marques-Sule, E., Taha, M. M., Gaber, M., & Atef, H. (2023). Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: A randomized controlled trial. Frontiers in Physiology. 

Link to study

About a third of chronic migraine sufferers overuse their prescribed pain medications. Medication overuse creates an additional problem because the medication effects wear off over the course of a day, triggering medication-withdrawal headaches. Standard treatment involves a gradual reduction in medication followed by the prescription of prophylactic medication and patient education. There have been some uncontrolled pilot studies suggested that mindfulness training may also be helpful for migraine sufferers. 

Grazzi et al. [Journal of Headache and Pain] conducted a phase-III randomized, controlled trial to test whether adding mindfulness training to treatment-as-usual (TAU) could improve headache frequency, medication overuse, and quality of life in chronic migraine sufferers.

The researchers randomly assigned 177 patients at an Italian specialty headache treatment center (average age = 48 years; 89% female) who met two criteria: 1) experienced at least 15 days of migraine and medication-withdrawal headaches per month, and 2) were overusing their medication. These patients were assigned to one of two groups: TAU or TAU plus mindfulness training.

All patients went through an intensive 5-8 day titrated medication withdrawal protocol as either inpatients or day patients. After discharge, they were provided with individually-tailored prophylactic medication regimes and received education on medication use, diet, exercise, sleep hygiene, and related health issues.

Patients in the TAU plus mindfulness group also participated in six  weekly 90-minute group mindfulness training sessions. Each session included mindfulness meditation practice (ranging in length from 5 minutes in the first sessions to 25 minutes by the fifth and sixth sessions). Additionally,  participants were asked to engage in 3-10 minutes of home meditation practice during weeks 3 to 6.

Patients were assessed at baseline and 3, 6, and 12 months using measures of headache frequency, disability, quality of life, and medication use.

By 12 months, a significantly higher proportion of patients in the TAU plus mindfulness group (78%) achieved a ≥50% reduction in headache frequency compared to the TAU group (48%). The TAU Plus mindfulness group showed significantly more improvement on measures of migraine-related quality of life and disability than the control group.

Further, the mindfulness group showed significantly greater reductions in pain medication use and lost productivity than the control group. Total migraine-related healthcare costs were $938 lower in the TAU plus mindfulness group as compared to controls at 12 month follow-up.

The study demonstrates that mindfulness training provides additional benefits beyond treatment-as-usual for migraine sufferers in terms of headache frequency, disability, lost productivity, medication usage, and associated healthcare costs.

The study focused on a specific patient population of severe migraineurs who were treated in an intensive headache specialty center. As such, the findings may not apply to other populations with different migraine severities or treatment settings. Patients in the mindfulness group received more attention and may have received more didactic information than TAU patients so all improvement may not be attributed to mindfulness practice.

Reference:

Grazzi, L., D’Amico, D., Guastafierro, E., Demichelis, G., Erbetta, A., Fedeli, D., Nigri, A., Ciusani, E., Barbara, C., & Raggi, A. (2023). Efficacy of mindfulness added to treatment as usual in patients with chronic migraine and medication overuse headache: A phase-III single-blind randomized-controlled trial (the MIND-CM study). The Journal of Headache and Pain, 24(1), 86. 

Link to study

Workplace Mindfulness-Based Interventions (MBIs) can result in increased well-being for employees, but do these benefits translate into objective measures such as reduced absenteeism? In a previously published study, researchers demonstrated that a workplace MBI could reduce the mental distress of supervisory staff and improve their health-related self-care.

Using a quasi-experimental design, Vonderlin et al. [Mindfulness] examined sick days from participants in the earlier study relative to a comparison group to test whether the MBI also reduced supervisor and supervisee absenteeism.

Twelve German corporations participated in the original study, with five of those corporations agreeing to have employee data used for the current study. Employee sick days were extracted from health insurance company records, limiting the data to employees insured by the cooperating health insurance company. As a result, the available sample comprised 13 supervisors out of the 147 who initially took part in the MBI. These supervisors supervised a total of 186 employees who were also covered by the cooperating insurance company and whose data could be retrieved.

Supervisor and supervisee sick day data were then compared with sick day data from a propensity score matched comparison group of 269 supervisors and 1,352 supervisees selected from a larger pool of enrollees from the cooperating health insurance company. Propensity score matching included matching for age, sex, employment status, and whether they were supervisory or supervised staff. The final sample averaged 44 years of age and was 78% female. The majority (88%) were employed in health care facilities such as hospitals and nursing homes.

The MBI program consisted of three full-day training sessions and two 3-hour booster sessions, with each session scheduled 4 weeks apart. The content of the MBI emphasized health-promoting self-care, health-promoting staff care, and addressing issues faced by stressed employees.

The mindfulness training was derived from Dialectical Behavioral Therapy’s mindfulness skills training module which involves mindfulness under daily life conditions rather than formal meditation practice. Sick days were recorded for two years before and two years after the MBI program.

The results showed that the group of MBI-trained supervisors had significantly reduced their average non-mental health related sick days from 33 days per two years to 14 sick days per two years, while the control group slightly increased sick days from an average of 32 to 34 days per two year period, a between group difference with a Cohen’s d=0.47. There was no group difference for mental health related sick days. 

It is worth noting that a closer analysis of the MBI-trained supervisor group indicated that the average non-mental health sick days can mislead. This was primarily due to one supervisor who took 215 sick days prior to the intervention. When median sick days were considered instead of mean sick days, the median for MBI-trained supervisors increased from 6 to 7 days, while the comparison group's median increased from 9 to 11 days.

German historical workplace data show that average sick days tend to increase annually. No significance test was offered for this difference. There were no within- or between-group significant differences in supervisee sick days.

The study suggests a workplace MBI, in addition to reducing mental distress and improving health related self-care, may reduce or slow the annual increase in supervisors’ sick days. The interpretation is complicated by multiple factors, including: 1) German health insurance companies only record sick days when there are more than three consecutive days absent, 2) the intervention group was small and had one influential outlier, 3) the comparison group was not a randomly-assigned control group, and 4) the mindfulness intervention did not involve formal meditation practice.

Reference:

Vonderlin, R., Schmidt, B., Biermann, M., Lyssenko, L., Heinzel-Gutenbrunner, M., Kleindienst, N., Bohus, M., & Müller, G. (2023). Improving Health and Reducing Absence Days at Work: Effects of a Mindfulness- and Skill-Based Leadership Intervention on Supervisor and Employee Sick Days. Mindfulness. 

Link to study

Almost one-third of all Americans will experience some form of anxiety disorder at some point in their lives. Behavioral scientists are trying to improve their understanding of anxiety disorders and find the most effective treatments. In one recent experimental paradigm, fear was defined as a response to a specific threat, while anxiety was defined as a response to the unpredictable possibility of encountering a threat. Within this paradigm, people with anxiety disorders show higher levels of anxiety compared to healthy controls, but not higher levels of fear. 

Hoge et al. [Biological Psychiatry] used this paradigm to compare the effects of Mindfulness-Based Stress Reduction (MBSR) and antidepressant medication on objective and subjective measures of fear and anxiety in individuals with anxiety disorders.

The researchers recruited a sample of 93 adults with anxiety disorders and 66 healthy controls (average age=33 years; 72% female; 63% Caucasian). Participants attended baseline lab sessions to measure their startle responses to fear- and anxiety-provoking stimuli. Participants with anxiety disorders were then randomly assigned to either participate in a standard 8-week MBSR program or receive a daily dose of escitalopram (the generic form of Lexapro) for eight weeks. The healthy controls received no intervention. At the end of the eight weeks, participants repeated the lab measure again to assess anxiety and fear responses. Participants also completed self-report measures of anxiety during both the baseline and post-intervention evaluations.

During the lab sessions, participants sat at a computer that displayed a series of images consisting of green circles, blue triangles, and red squares. Participants were administered annoying (but not painful) electrical shocks in conjunction with these visual stimuli. Prior to the presentation of each image series, the computer screen provided information about the nature of the trial. Some trials involved no electrical shocks (neutral trials), while in others, shocks were administered only when a red triangle was present (predictable shock trials). There were also trials where shocks could occur during any stimulus (unpredictable shock trials).

An electromyogram (EMG) was used to measure the magnitude of each participants’ eye blinks—an objective measure of startle response—after exposure to each image. Eye blinks during predictable shock trials were classified as fear startle responses, whereas those during unpredictable shock trials were classified as anxiety startle responses.

Results showed that the group with anxiety disorders had significantly higher anxiety startle responses at baseline compared to the healthy control group. However, their response magnitudes significantly decreased after the intervention, leading to no significant difference between the two groups post-intervention. The reduction in anxiety startle responses was significantly greater for the escitalopram group than the MBSR group.

Subjective anxiety ratings decreased significantly for both intervention groups, a change that was significantly correlated with decreases in the anxiety startle response (r=.27) but not the fear startle response (r=.07). Intervention and control groups did not differ in the magnitude of their fear startle responses at baseline or post-intervention. While the MBSR group significantly reduced fear startle responses and fear subjective ratings from pre- to post-intervention, the escitalopram group did not.

The study shows that both MBSR and escitalopram reduce objective and subjective levels of anxiety so that participants with anxiety-disorders in both interventions no longer differed from healthy controls after intervention. Escitalopram reduced the magnitude of anxiety startle responses more than MBSR, whereas MBSR reduced the magnitude of fear startle responses more than escitalopram. This discrepancy suggests the involvement of distinct mechanisms of action for each intervention.

The study is limited by the absence of a non-intervention control condition for participants with anxiety disorders. 

Reference:

Hoge, E. A., Armstrong, C. H., Mete, M., Oliva, I., Lazar, S. W., Lago, T. R., & Grillon, C. (2023). Attenuation of Anxiety-Potentiated Startle After Treatment with Escitalopram or Mindfulness Meditation in Anxiety Disorders. Biological Psychiatry. 

Link to study

The relation between major depressive disorder and brain iron concentrations remains speculative. The brain requires iron for various functions, including dopamine synthesis, myelin formation, oxygen transport, and energy metabolism. However too much iron can cause inflammation and neurotoxicity. Studies have shown that depressed patients have increased concentrations of iron in their hair and nails and decreased concentrations of iron in their blood, but these studies tell us nothing about iron levels in the brain.

Since iron is ferromagnetic, Magnetic Resonance Imaging (MRI) offers a non-invasive method to measure brain iron concentrations. Several studies employing older MRI technology demonstrated elevated levels of iron in specific brain regions among patients with severe depression.

Jakary et al. [Journal of Affective Diseases] used a newer and more powerful ultra-high field 7 Tesla MRI method, which offers increased sensitivity in measuring brain iron concentration. The researchers used this technology to quantify brain iron concentrations in individuals with major depressive disorder participating in Mindfulness-Based Cognitive Therapy (MBCT) and compared their iron levels and cognitive functioning to that of healthy controls.

The researchers recruited 17 medication-free patients diagnosed with major depressive disorder (76% female; average age = 31) and 14 age- and gender-matched healthy controls. Participants with depression were assessed for brain iron concentrations, depressive symptoms, and cognitive functioning before and after participating in MBCT. The regions of interest for MRI brain analysis  included the anterior cingulate cortex, caudate, putamen, globus pallidus, and thalamus. The MRI measurements involved assessing local field shifts (LFS) in gradient-recalled echo phase images, where lower LFS values indicate higher iron concentration levels.

MBCT was delivered in 8 weekly 2.5 hour group sessions with 30-45 minutes of daily home practice. Twelve of the patients successfully completed MBCT and all the MRI assessments. Healthy controls did not participate in MBCT and were assessed on all measures at baseline only.

The results showed that, at baseline, depressed patients exhibited significantly higher iron concentrations in the left global pallidus and putamen, as well as significantly slower information processing speed on cognitive tests compared to healthy controls. Depressive severity in depressed patient group was correlated with significantly higher iron concentrations in five brain regions of interest.

All MBCT participants experienced a meaningful improvement in their depressive symptoms after MBCT, with six individuals experiencing complete depression remission. Depressed patients also significantly improved on measures of executive function and attention after MBCT. 

Brain iron concentrations did not change significantly from baseline to post-treatment, and changes in values were uncorrelated with improvements in depression scores. However, patients with higher iron concentrations in the right caudate nucleus at baseline showed significantly greater posttreatment improvement in depressive symptoms.

In addition, patients with higher iron concentrations in three regions of interest at baseline showed significantly greater improvement on a measure of verbal learning and memory after MBCT. 

The study demonstrates that using the ultra-high field MRI method enables the detection of brain iron concentrations in specific regions of interest, which can serve as biomarkers for depression and its response to MBCT. The study is limited by technical factors (e.g., how myelin alterations may affect LFS values) that may reduce the validity LFS values as a surrogate measure of iron concentration and the absence of a no-treatment control.

Reference:

Jakary, A., Lupo, J. M., Mackin, S., Yin, A., Murray, D., Yang, T., Mukherjee, P., Larson, P., Xu, D., Eisendrath, S., Luks, T., & Li, Y. (2023). Evaluation of major depressive disorder using 7 Tesla phase sensitive neuroimaging before and after mindfulness-based cognitive therapy. Journal of Affective Disorders, 335, 383–391. 

Link to study

About 10% of patients who are prescribed opioids for their chronic pain go on to develop opioid use disorders, which are characterized by urges to use, difficulty in tapering off use, and impairment in daily activities. Given that mindfulness-based interventions have been used for the treatment of chronic pain and substance abuse disorders, they may also offer potential benefits to people who are diagnosed with both disorders concurrently. 

Ellerbroek et al. [Brain and Behavior] conducted a pilot study aimed at assessing the feasibility of using Mindfulness-Based Cognitive Therapy (MBCT) among patients with co-occurring chronic pain and opioid use disorder.

The researchers recruited 23 Dutch patients (60% female; average age = 48 years) who had dual diagnoses of chronic pain and opioid use disorder and were hospitalized for the initiation of opioid-agonist buprenorphine/naloxone treatment. All participants were given the opportunity to participate in outpatient MBCT three months after their hospitalization. MBCT was delivered in the standard curriculum format of 8-week 2.5 hour group sessions and a 6-hour retreat.

The MBCT groups were not restricted to study patients alone, but also included patients with other psychiatric diagnoses. Study patients were interviewed prior to the start of MBCT to assess factors that might facilitate or hinder their participation. Patients who initially agreed to participate in MBCT but later declined were interviewed on two occasions. Patients who participated in MBCT were also interviewed post-intervention to assess their perception of whether and how they had changed. Interviews were audiotaped, transcribed, coded, and thematically analyzed.

Nine patients initially declined to participate in MBCT. Their reasons included previous MBI experience, being in too much pain, fear that participation could exacerbate pain and negative mood, challenges related to travel and scheduling conflicts with sessions, and a general lack of interest in psychosocial interventions. Twelve patients initially expressed interest in participating, but during the three months leading up to the start of the intervention, eight of them changed their minds. Many of those thought MBCT was occurring too late in their treatment process or were anticipating practical difficulties that would hinder their attendance.

Four patients participated in MBCT: one attended all 8 sessions, two attended 7 sessions, one attended 6 sessions, and all attended the 6-hour retreat. Participants reported being more in touch with their emotions and better able to focus their attention, diminished self-blame, anxiety, and anger, and a greater ability to experience happiness and calm. While their pain levels did not generally decrease, they reported coping better with pain by employing strategies of acceptance, letting go, and seeking distraction.

The researchers concluded that although patients derived benefits from participating in the intervention, MBCT was not feasible for most individuals with co-occurring chronic pain and opioid use disorder. Offering MBCT earlier in the treatment cycle, providing a trial session prior to requiring a commitment, or offering MBCT in an individualized online format were noted as potential strategies to address barriers to feasibility.

The study is limited by its small number of participants and lack of objective outcome measures.

Reference:

Ellerbroek, H., Hanssen, I., Lathouwers, K., Cillessen, L., Dekkers, S., Veldman, S. E., van den Heuvel, S. A. S., Speckens, A. E. M., & Schellekens, A. F. A. (2023). Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change. Brain and Behavior.

Link to study

Although behavior therapies are increasingly integrating mindfulness meditation, little is known about how this practice affects reward-based conditioning. Some research suggests that mindfulness can assist individuals in responding more rapidly to changes in reward contingencies, but it is not clear why.

One possibility is that people learn verbal rules that help them respond to specific reward schedules, and mindfulness enables people to let go of previously learned verbal rules that no longer apply when reward schedules change. Another possibility is that mindfulness helps people pay closer attention to the reward schedule that is currently in effect.

Reed [Journal of Experimental Psychology: Animal Learning and Cognition] conducted four experiments to investigate how mindfulness affects responses to changes in reward schedule. Two different reward schedules were used in the experiments: 1) a random ratio (RR) schedule, which rewarded participants only after a certain number of responses, and 2) a random interval (RI) schedule, which rewarded participants only after a certain amount of time had elapsed. The RR schedule encouraged rapid bursts of responses, whereas the RI schedule encouraged participants to pause for a while after receiving a reward. All four studies used healthy, meditation-naïve participants drawn from a university psychology department.

The first study explored whether mindfulness could help people better differentiate between schedules—that is, to respond at higher rates during an RR schedule and lower rates during an RI schedule. Forty participants (58% male; average age = 21 years) sat at a computer and pressed a space bar with the goal of maximizing game points. Every participant completed 8 alternating RR and RI schedule trials. A yellow or brown screen icon appeared that indicated the trial was an RR or RI trial, but participants were not informed of what the color signified.

A rewarded trial earned participants 60 points, but each space bar press cost them one point. The RR schedule offered a reward after 20 space bar presses, whereas the RI schedule offered a reward for the first space bar press after a certain period of time had elapsed. 

Prior to playing the game, participants were randomly assigned to a 10-minute mindfulness or relaxation intervention, delivered via audio recording. The mindfulness intervention asked participants to focus on their breath and return to it whenever their minds wandered. The relaxation intervention asked participants to relax and let their minds wander.

Both groups gradually increased their response rates during RR and decreased them during RI, but the mindfulness group showed a significantly greater differentiation between the schedules. This supports the hypothesis that mindfulness helps one pay better attention to reward schedules.

The second study investigated whether a mindfulness group would respond faster to a change in contingency schedule than a relaxation control. Thirty-two participants (75% male, average age = 21 years) were randomly assigned to a mindfulness or relaxation intervention. The experimental situation was the same as in study 1, except that the color icons associated with each schedule were switched midway through the game.

The results showed that, once again, the mindfulness group was better able to differentiate between the schedules than the control group.  In addition, they responded faster to changes in reward contingency and to changes in the color signaling the contingency, compared to the controls. 

The third study compared the effects of mindfulness versus a no-intervention control on the speed of contingency reversal learning using 32 participants (69% male; average age = 24 years). In this study, participants were asked to verbalize the rule they thought was in effect after each trial.

In study 3, participants first completed four trials of the game before experiencing the mindfulness or control intervention. They then played eight trials, as in study 2. The mindfulness group significantly outperformed controls in differentiating between the RR and RI schedules and accurately verbalizing the contingency in effect for each trial.

The forth study examined whether mindfulness works by promoting awareness of current contingencies or by reducing interference from previously learned contingencies using 80 participants (64% female; average age = 21 years). Participants were trained on an alternating RR/RI schedule until their response rate was higher during the RR schedule. They then randomly assigned to mindfulness or relaxation training. Half of each group play the game as noted before, while the other half played the game with the color icon signaling the reward contingency switched.

The results were consistent with the prior studies. The mindfulness group recognized changes in contingency faster and showed a more differentiated response to them than controls. Moreover, the mindfulness group responded appropriately to the changed contingencies after the icon switching faster than controls. The results support the hypothesis that mindfulness promotes situational awareness, leading to more appropriate responding to reward contingencies.

Taken together, these studies demonstrate mindfulness increases behavior differentiation between reward schedules compared to relaxation and no-treatment controls. Mindfulness also leads to faster learning of reward schedule switches. Finally, it appears to enhance performance by increasing present-moment awareness, rather than by reducing interference from previous learning. Although the study’s “relaxation” intervention conflates relaxation with mind-wandering, it does not alter the overall interpretation of the findings. 

Reference:

Reed, P. (2023). Focused-attention mindfulness increases sensitivity to current schedules of reinforcement. Journal of Experimental Psychology: Animal Learning and Cognition, 49, 127–137. 

Link to study

High-stakes exams can determine one’s future in terms of promotion, graduation, acceptance into a university, or employment. School mathematics exams are especially high-stake in East-Asian cultures where examinations have long been a prime means of advancement. Fears over how math test performance may affect one’s future, or how family and peers might react can lead to considerable test anxiety. This can create a cycle where anxiety impairs performance, and impaired performance exacerbates anxiety.

Zuo & Wang [Frontiers in Psychology] used quantitative and qualitative methods to investigate how a mindfulness-based intervention affected math test performance in Chinese middle-school students.

The researchers selected an eighth-grade class of middle school students (67% male: age range = 12-13 years) in an urban area of Jiangsu Province, China. The study lasted for one month, during which the students took four weekly geometry tests rated as equivalent in difficulty. The first and third tests were taken as usual, but for the second and fourth tests, the students listened to a 15-minute audio tape prior to the test.

The audio tape contained a breath-and-body focused meditation and included relaxation instructions. The tape also instructed students to imagine having negative thoughts and emotions during a math test, and to identify these thoughts and emotions non-judgmentally and return to present-moment awareness. 

After the fourth test, students participated in group discussions about whether they found the meditations useful. Two students who benefitted from meditation and two students who did not were selected for subsequent in-depth interviews. The discussion and  interviews were transcribed, coded, and thematized to offer qualitative insights into how the meditations affected student math anxiety and self-efficacy.

The results showed that students performed better on average after the meditations than without them (Cohen’s d = 0.27). All math tests were scored on a 10-point scale, with an average score of 6.73 without meditation and 7.11 with meditation.

The qualitative analysis revealed that the meditations helped students to focus more on math problems in the moment, worry less about performance outcomes, and obsess less over test time-constraints or difficult problems. The students who didn’t benefit reported finding the meditations “mysterious” or “magic” and associated them negatively with Buddhist religion. 

The study shows a mindfulness meditation specifically designed to address math anxiety can objectively improve math exam performance. Qualitative interviews revealed that the students who benefited from meditation were able to focus more on solving math problems without being distracted. The study is limited by its reliance on a single classroom sample and only four measurement points.  

Reference:

Zuo, H., & Wang, L. (2023). The influences of mindfulness on high-stakes mathematics test achievement of middle school students. Frontiers in Psychology, 14. 

Link to study