News

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

Studies of the short-term effects of mindfulness meditation on cognitive performance often show conflicting findings. These differences in study findings may result from heterogeneity in the populations, meditation methods, cognitive tasks, and study designs used, and the extent of participant’s prior meditation experience. 

Sleimen-Malkoun, et al. [PLOS One] attempted to clarify the effects of short-term mindfulness meditation on cognitive performance by comparing it to a control intervention and studying its effect on cognitive reaction time in both experienced and novice meditators.

Forty-two healthy French adults, including 22 experienced meditators (64% female; mean age = 49 years) and 20 meditation-naïve participants (55% female; mean age = 42 years), were enrolled in the study. Experienced meditators meditated at least 3 times weekly over an average of over 5 years (range = 5-250 months), while meditation-naïve participants had no prior meditation experience.

Participants’ resting heart rates were recorded and they then performed a baseline Stroop task. Afterwards, half the participants engaged in 10 minutes of guided breath-focused mindfulness meditation while the other half actively listened to a 10 minute pre-recorded audio on the history, origins, and philosophy of mindfulness meditation without guided practice.

Participants then performed a repeat Stroop task. At this point, participants initially in the mindfulness condition were now assigned to the listening condition, and vice versa so that participants served as their own controls. Participants then completed a third Stroop task. Heart rate was monitored during both interventions.

The Stroop task was a cognitive performance task that involved showing participants computer-presented slides of colored words. Sometimes the words spelled the names of colors (e.g., “RED”), and when that happened, sometimes the text color agreed with the word name  (congruent condition), and at other times text color and word name were discordant (incongruent condition). There were also times when the words named parts of the body, so that their color was irrelevant (neutral condition).

Participants were asked to identify the color the words were printed in and their reaction times were recorded. The Stroop task is a commonly used measure of participants’ attentiveness and ability to ignore distracting information.

The results showed Stroop reaction times to congruent and incongruent color word presentations were significantly faster after mindfulness meditation than after active listening. Average heart rates were significantly slower during active listening than while at rest, and significantly slower still while meditating.

The extent of participants’ prior meditation experience did not interact with experimental condition to affect Stroop reaction time or heart rate. 

The study shows that a brief 10-minute mindfulness meditation is associated with slowed heart rate and improved Stroop task reaction times in both experienced and novice meditators. Acute cognitive benefit accrues after a brief meditation, even for novices.

The study is limited by its reliance on the Stroop task as the single outcome measure representing cognitive performance.

Reference:

Sleimen-Malkoun, R., Devillers-Réolon, L., & Temprado, J.-J. (2023). A single session of mindfulness meditation may acutely enhance cognitive performance regardless of meditation experience. PLOS ONE, 18(3), e0282188. 

Link to study

Our mental health system is unable to provide care to all who need it: there are too few providers and many clients cannot afford or access it. There is a need to creatively rethink how to offer care to more in need. One way is through self-help workbooks that allow clients to work on problems at their own pace while assisted by limited paraprofessional support.

British National Health Service guidelines currently endorse practitioner-supported Cognitive Behavioral Therapy Self-Help (CBT-SH) for depression. The National Health Service currently offers CBT-SH to over 100,000 clients annually, but the intervention suffers from a high drop-out rate. 

Practitioner-supported Mindfulness-Based Cognitive Therapy Self-Help (MBCT-SH) is one possible alternative to CBT-SH, but its comparative efficacy is unknown. Strauss et al. [JAMA Psychiatry] conducted a randomized controlled trial comparing CBT-SH to MBCT-SH on clinical outcomes and cost effectiveness. 

The researchers randomly assigned 410 clients with mild-to-moderate depression (62% female; 86% Caucasian; median age = 32) to practitioner-supported CBT-SH or MBCT-SH. Initial diagnosis and level of depression was established by structured clinical interview and self-report.

Participants were handed CBT or MBCT self-help workbooks and provided with six structured face-to-face or telephone 30-45 minute sessions with a psychological well-being practitioner focused on workbook material. “Psychological well-being practitioner” is a paraprofessional designation created through the British National Health Service’s Improving Access to Psychological Services (IAPS) initiative. 

The CBT workbook used in this study was one already in wide use in IAPS programs. The MBCT workbook was The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress written by the MBCT co-founders. Participants were given up to 16 weeks to complete the workbook curricula.

Participants were assessed on measures of depression, anxiety, quality of life and mindfulness at baseline, 16 weeks (post-intervention) and 42-week follow-up. Drop-out rates for both groups were similar (28%).

MBCT-SH participants reported greater reductions in depression at post-intervention than CBT-SH participants (d=-0.36) but the group difference was no longer significant at 42 weeks.  MBCT-SH participants also reported greater improvement in anxiety than CBT-SH participants at postintervention (d=-0.23), but not at 42 weeks. The absence of significant differences at 42 weeks reflects a continued improvement in depression for both groups. 

The direct costs of providing treatment were $209 for MBCT-SH and $202 for CBT-SH. Other health care and social costs were higher for the CBT-SH group ($1,684) than the MBCT-SH group ($923). The increased CBT-SH costs were due to participants receiving more individual psychotherapy outside of the program, receiving more general practitioner visits, and the higher psychotropic medication usage.

The results show MBCT-SH superior to CBT-SH as a treatment for mild-moderate depression in terms of post-intervention mental health outcome and lower health care and social costs. Findings make a case for considering MBCT-SH to be at least as effective as CBT-SH and including it within the IAPS initiative. 

Reference:

Strauss, C., Bibby-Jones, A.-M., Jones, F.,... Cavanagh, K. (2023). Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial. JAMA Psychiatry. 

Link to study

Treatments for excessive alcohol use are often only moderately successful, and clinicians are always on the lookout for more effective interventions. Mindfulness-Based Relapse Prevention (MBRP) is a promising intervention that combines standard cognitive-behavioral relapse prevention with teaching substance users to mindfully resist acting impulsively on urges. 

Most existing MBRP research with persons with alcohol use disorders does not compare MBRP to other empirically validated treatments. Skrzynski et al. [Journal of Studies on Alcohol and Drugs] tested the relative efficacy of MBRP to standard relapse prevention alone in reducing alcohol use in heavy alcohol users.

The researchers randomly assigned 182 heavy alcohol users (52% male; 92% Caucasian; average age = 44 years) who volunteered because they wished to reduce their drinking to MBRP or relapse prevention alone. At baseline, participants drank an average of 5 drinks per day, and had 12 heavy drinking days per month when they consumed more than 4 drinks per day. Forty-two percent also used cannabis at least once the past month.

Both treatments were delivered in eight weekly individual therapy sessions delivered over the course of 2 months, with follow-up appointments at weeks 20 and 32. Therapy was delivered by doctoral and post-doctoral psychology students with 3 days of specialized training in motivational interviewing, MBRP, and relapse prevention.

Assessments at baseline, 4, 8, 20, and 32 weeks included an alcohol use questionnaire and timeline follow-back measures of alcohol use based on self-report.

The results showed that both groups significantly reduced their scores on an alcohol use questionnaire, and their average number of drinks per day and total number of heavy drinking days significantly declined from baseline to posttreatment.

While reduction in heavy drinking days was equal for both groups at posttreatment, MBRP participants maintained their improvement in heavy drinking days in subsequent follow-up, whereas the relapse prevention group did not. By the end of the study, the MBRP participants had significantly fewer heavy drinking days than controls. 

The efficacy of the treatment was equal for males and females. High levels of cannabis use led to continued decreases in the MBRP group in drinks per day and heavy drinking days in the follow-up period, but to increases in heavy drinking days in controls.

The study showed that MBRP and relapse prevention alone were equally effective in reducing drinks per day and heavy drinking days in alcohol users who wished to reduce their drinking, but only MBRP helped participants maintain their reduction in heavy drinking days out to 32 weeks. 

The study is limited by potential participants being aware that the study treatment included mindfulness, and 18% of the sample had a history of experience with mindfulness. It is unclear whether the same results would obtain in a meditation-naïve cohort or one less favorable to the idea of mindfulness.

The study is also limited by the relative inexperience of the students conducting the MBRP and relapse prevention interventions. 

Reference:

Skrzynski, C. J., Karoly, H., Ellingson, J., Hangerty, S., Bryan, A. D., & Hutchison, K. E. (2023). Comparing the efficacy of mindfulness-based relapse prevention versus relapse prevention for alcohol use disorder: A randomized control trial. Journal of Studies on Alcohol and Drugs.

Link to study

Moral decision making sometimes involves weighing trade-offs between self-serving interests and causing harm to others. Social psychology experiments reveal a moral “slippery slope.” That is, once experimental participants begin making decisions that serve their own interests but harm others, they progressively become more self-serving and less concerned about harm to others as time goes on. Moral decision-making includes decisions about what actions to take as well as judgments about how ethical those decisions are. 

Mindfulness training might affect how moral decisions are made and judged by cultivating a present-moment focus that reduces goal-oriented behavior (seeking future gain) or by increasing empathy for others. Du et al. [Scientific Reports] tested the effect of  Mindfulness-Based Stress Reduction (MBSR) on moral decision-making involving tradeoffs between benefits to self and harm to self and others.

The researchers randomly assigned 68 meditation-naïve Chinese participants (75% female; Average age = 30 years) to either an 8-week MBSR course or a wait-list control. The MBSR protocol was the standard MBSR protocol delivered in a Chinese-language format. All participants engaged in moral decision making and judgment tasks and completed Chinese-language versions of mindfulness (the Five Factor Mindfulness Questionnaire), emotional regulation, and failures in executive control (problems in planning, impulsivity, and motivation) questionnaires one week prior to and after intervention. 

In the moral decision-making task, participant pain thresholds were assessed to determine the level of electric shock needed to evoke a pain of “8” on a 10-point pain scale. Participants then engaged in a series of 96 decision making trials in which they chose between receiving various amounts of money while receiving painful shocks or giving them to another “person” in the next room. There was, in fact, no other person in the next room. Participants then rated the other “person’s” choices on the same task in terms of how moral their decisions were

Results from the study showed that mindfulness and executive control scores were significantly higher in the MBSR group as compared to controls after the intervention. While the control group showed an increased willingness to inflict harm on another as compared to oneself from pre- to post-testing (the “slippery slope” effect), the MBSR group did not (partial η2= 0.08).

Using Bayesian hierarchical drift diffusion modeling, the researchers established that the amount of money participants received for each decision had less of an effect on MBSR decision-makers than controls. In other words, MBSR suppressed the influence of increases in money on moral decision-making, whereas controls were more likely to morally justify causing harm to others when the amount of monetary compensation was sufficiently high.

MBSR did not make participants more moral compared to their own baseline but reduced the magnitude of the slippery slope compared to controls.

In terms of moral judgment, participants became less judgmental of other’s choices from pretesting to post-testing. Participants weighted the importance of money more and the importance of pain less during post-testing than pretesting. There was a difference between groups in this effect, however. For controls, the same amount of money justified more harm in post-testing than pretesting, whereas the amount of money had less of an effect on the mindfulness group’s judgment.

The study shows MBSR can shift the relative value of monetary gain in moral decision making and judgment involving harm compared to a wait-list control.

The study is limited by the lack of an active control and the possibility that group differences in moral performance may owe more to the demand characteristics of having been in a mindfulness condition than to cognitive changes due to mindfulness per se.

Reference:

Du, W., Yu, H., Liu, X., & Zhou, X. (2023). Mindfulness training reduces slippery slope effects in moral decision-making and moral judgment. Scientific Reports, 13(1), 2967. 

Link to study