Skip to main content

How Do Mindfulness-Based Interventions Work? Strategies for Studying Mechanisms of Change in Clinical Research

  • Chapter
Handbook of Mindfulness and Self-Regulation

Abstract

Randomized controlled trials of mindfulness-based interventions have demonstrated beneficial effects of treatment across a variety of disorders (Keng et al., Clin Psych Rev 31:1041-1056, 2011). More research is needed to determine the mechanisms through which these treatments improve psychological functioning. This chapter provides a variety of concrete recommendations for conducting methodologically rigorous studies, including design, sample, psychometric, and statistical considerations. Because reliable and valid assessment of mindfulness is critical to research on mechanisms of change, we review the available tools for measuring trait and state mindfulness processes. In addition, a brief review of treatment-based mediational studies is included, revealing the need for more theory-based, systematic exploration of mediational pathways. By optimizing and standardizing methods in this area of research, clinical scientists can hasten accumulation of knowledge about how mindfulness-based interventions work.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849–1858.

    Article  PubMed  Google Scholar 

  • Baer, R. A. (2011). Measuring mindfulness. Contemporary Buddhism, 12, 241–261.

    Article  Google Scholar 

  • Baer, R. A., Lykins, E. L. B., & Peters, J. R. (2012). Mindfulness and self-compassion as predictors of psychological well-being. Journal of Positive Psychology, 7, 230–238.

    Article  Google Scholar 

  • Baer, R. A., Samuel, D. B., & Lykins, E. L. (2011). Differential item functioning on the Five Facet Mindfulness Questionnaire is minimal in demographically matched meditators and nonmeditators. Assessment, 18(1), 3–10.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27–45.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S. E., et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329–342.

    Article  PubMed  Google Scholar 

  • Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. Assessment, 11, 191–206.

    Article  PubMed  Google Scholar 

  • Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Article  PubMed  Google Scholar 

  • Bauer, D. J., Preacher, K. J., & Gil, K. M. (2006). Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: New procedures and recommendations. Psychological Methods, 11, 142–163.

    Article  PubMed  Google Scholar 

  • Baum, C., Kuyken, W., Bohus, M., Heidenreich, T., Michalak, J., & Steil, R. (2010). The psychometric properties of the Kentucky Inventory of Mindfulness Skills in clinical populations. Assessment, 17, 220–229.

    Article  PubMed  Google Scholar 

  • Bergomi, C., Tschacher, W., & Kupper, Z. (2013). Measuring mindfulness: First steps towards the development of a comprehensive mindfulness scale. Mindfulness, 4, 18–32.

    Google Scholar 

  • Bieling, P., Hawley, L., Bloch, R., Corcoran, K., Levitan, R., Young, L., et al. (2012). Treatment-specific changes in decentering following mindfulness-based cognitive therapy versus antidepressant medication of placebo for prevention of depressive relapse. Journal of Consulting and Clinical Psychology, 80, 365–372.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. C., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11, 230–241.

    Google Scholar 

  • Bond, F., & Bunce, D. (2000). Mediators of change in emotion-focused and problem focused worksite stress management interventions. Journal of Occupational Health Psychology, 5, 156–163.

    Article  PubMed  Google Scholar 

  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire - II: A revised measure of psychological flexibility and experiential avoidance. Behavior Therapy, 42, 676–688.

    Article  PubMed  Google Scholar 

  • Bowen, S., Witkiewitz, K., Dillworth, T., & Marlatt, G. A. (2007). The role of thought suppression in the relationship between mindfulness meditation and alcohol use. Addictive Behaviors, 32, 2324–2328.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bränström, R., Kvillemo, P., Brandberg, Y., & Moskowitz, J. T. (2010). Self-report mindfulness as a mediator of psychological well-being in a stress reduction intervention for cancer patients: A randomized study. Annals of Behavioral Medicine, 39, 151–161.

    Article  PubMed  Google Scholar 

  • Broderick, P. C. (2005). Mindfulness and coping with dysphoric mood: Contrasts with rumination and distraction. Cognitive Therapy and Research, 29, 501–510.

    Article  Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being in the present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84, 822–848.

    Article  PubMed  Google Scholar 

  • Brown, K. W., Ryan, R. M., Loverich, T. M., Biegel, G. M., & West, A. M. (2011). Out of the armchair and into the streets: Measuring mindfulness advances knowledge and improves interventions: Reply to Grossman (2011). Psychological Assessment, 23(4), 1041–1046.

    Article  Google Scholar 

  • Buchheld, N., Grossman, P., & Walach, H. (2001). Measuring mindfulness in insight meditation and meditation-based psychotherapy: The development of the Freiburg Mindfulness Inventory (FMI). Journal for Meditation and Meditation Research, 1, 11–34.

    Google Scholar 

  • Cardaciatto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2007). The assessment of present-moment awareness and acceptance: The Philadelphia Mindfulness Scale. Assessment, 15, 204–223.

    Article  Google Scholar 

  • Carmody, J., & Baer, R. A. (2008). Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. Journal of Behavioral Medicine, 31, 23–33.

    Article  PubMed  Google Scholar 

  • Chadwick, P., Hember, M., Mead, S., Lilley, B., & Dagnan, D. (2008). Responding mindfully to unpleasant thoughts and images: Reliability and validity of the Southampton Mindfulness Questionnaire. British Journal of Clinical Psychology, 47, 451–455.

    Article  PubMed  Google Scholar 

  • Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7, 309–319.

    Article  Google Scholar 

  • Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study. Behavior Modification, 31, 543–568.

    Article  PubMed  Google Scholar 

  • Davis, K. M., Lau, M. A., & Cairns, D. R. (2009). Development and preliminary validation of a trait version of the Toronto Mindfulness Scale. Journal of Cognitive Psychotherapy, 23, 185–197.

    Article  Google Scholar 

  • Edwards, J. R., & Lambert, L. S. (2007). Methods for integrating moderation and mediation: A general analytic framework using moderated path analysis. Psychological Methods, 12, 1–22.

    Article  PubMed  Google Scholar 

  • Eisenlohr-Moul, T. A., Walsh, E. C., Charnigo, R. J., Lynam, D. R., & Baer, R. A. (2012). The “what” and the “how” of dispositional mindfulness: Using interactions among subscales of the Five Facet Mindfulness Questionnaire to understand its relation to substance use. Assessment, 19(3), 276–286.

    Article  PubMed Central  PubMed  Google Scholar 

  • Erisman, S. M., & Roemer, L. (2010). A preliminary investigation of the effects of experimentally induced mindfulness on emotional responding to film clips. Emotion, 10(1), 72.

    Article  PubMed Central  PubMed  Google Scholar 

  • Erisman, S. M., & Roemer, L. (2012). A preliminary investigation of the process of mindfulness. Mindfulness, 3, 30–43.

    Article  Google Scholar 

  • Feldman, G. C., Hayes, A. M., Kumar, S. M., Greeson, J. G., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: The development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29, 177–190.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, D.C.: American Psychiatric Press.

    Google Scholar 

  • Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772–799.

    Article  PubMed  Google Scholar 

  • Fresco, D. M., Moore, M., van Dulmen, M., Segal, Z. V., Ma, S. H., Teasdale, J. D., et al. (2007). Initial psychometric properties of the Experiences Questionnaire: Validation of a self-report measure of decentering. Behavior Therapy, 38, 234–246.

    Article  PubMed  Google Scholar 

  • Grossman, P. (2011). Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re)invention of mindfulness: Comment on Brown et al. Psychological Assessment, 23(4), 1034–1040.

    Article  PubMed  Google Scholar 

  • Grossman, P., & Van Dam, N. (2011). Mindfulness, by any other name: Trials and tribulations of sati in western psychology and science. Contemporary Buddhism, 12, 219–239.

    Article  Google Scholar 

  • Hargus, E., Crane, C., Barnhofer, T., & Williams, J. M. G. (2010). Effects of mindfulness on meta-awareness and specificity of describing prodromal symptoms in suicidal depression. Emotion, 10, 34–42.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hayes, A. F. (2012). PROCESS: A versatile computational tool for observed variable mediation, moderation, and conditional process modeling. White paper. Retrieved from http://www.afhayes.com/public/process2012.pdf.

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, process, and outcomes. Behavior Research and Therapy, 44, 1–25.

    Article  Google Scholar 

  • Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578.

    Google Scholar 

  • Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York, NY: Guilford.

    Google Scholar 

  • Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168.

    Article  PubMed  Google Scholar 

  • Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6, 537–559.

    Article  PubMed  Google Scholar 

  • Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., et al. (2007). A randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33, 11–21.

    Article  PubMed  Google Scholar 

  • Jha, A. P., Stanley, E. A., Kiyonaga, A., Wong, L., & Gelfand, L. (2010). Examining the protective effects of mindfulness training on working memory capacity and affective experience. Emotion, 10, 54–64.

    Article  PubMed  Google Scholar 

  • Kabat-Zinn, J. (1990). Full catastrophe living. New York, NY: Bantam Doubleday.

    Google Scholar 

  • Keng, S., Smoski, J. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical Psychology Review, 31, 1041–1056.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kline, R. B. (2010). Principles and practice of structural equation modeling (3rd ed.). New York, NY: Guilford Press.

    Google Scholar 

  • Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.

    Article  PubMed  Google Scholar 

  • Kuehner, C., Huffziger, S., & Liebsch, K. (2009). Rumination, distraction and mindful self-focus: effects on mood, dysfunctional attitudes and cortisol stress response. Psychological Medicine, 39(2), 219.

    Article  PubMed  Google Scholar 

  • Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R., Byford, S., et al. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48, 1105–1112.

    Article  PubMed  Google Scholar 

  • Lau, M. A., Bishop, S. R., Segal, Z. V., Buis, T., Anderson, N. D., Carlson, L., et al. (2006). The Toronto Mindfulness Scale: Development and validation. Journal of Clinical Psychology, 62, 1445–1467.

    Article  PubMed  Google Scholar 

  • Leigh, J., & Neighbors, C. (2009). Enhancement motives mediate the positive association between mind/body awareness and college student drinking. Journal of Social and Clinical Psychology, 28, 650–669.

    Article  PubMed Central  PubMed  Google Scholar 

  • Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43(4), 741–756.

    Article  PubMed  Google Scholar 

  • MacCoon, D. G., Imel, Z. E., Rosenkranz, M. A., Sheftel, J. G., Weng, H. Y., Sullivan, J. C., et al. (2011). The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behaviour Research and Therapy, 50, 3–12.

    Article  PubMed Central  PubMed  Google Scholar 

  • MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.

    Article  PubMed Central  PubMed  Google Scholar 

  • Marsh, H. W., Lüdtke, O., Robitzsch, A., Trautwein, U., Asparouhov, T., Muthén, B. O., et al. (2009). Doubly-latent models of school contextual effects: Integrating multilevel and structural equation approaches to control measurement and sampling errors. Multivariate Behavioral Research, 44, 764–802.

    Article  Google Scholar 

  • Moore, R. G., Hayhurst, H., & Teasdale, J. D. (1996). Measure of awareness and coping in autobiographical memory: Instruction for administering and coding. Cambridge, UK: University of Cambridge. Unpublished manuscript.

    Google Scholar 

  • Muller, D., Judd, C. M., & Yzerbyt, V. Y. (2005). When mediation is moderated and moderation is mediated. Journal of Personality and Social Psychology, 89, 852–863.

    Article  PubMed  Google Scholar 

  • Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identify, 2, 223–250.

    Article  Google Scholar 

  • Nyklíček, I., & Kuijpers, K. (2008). Effects of mindfulness-based stress reduction intervention on psychological well-being and quality of life: Is increased mindfulness indeed the mechanism? Annals of Behavioral Medicine, 35, 331–340.

    Article  PubMed Central  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36, 717–731.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.

    Article  PubMed  Google Scholar 

  • Preacher, K. J., & Selig, J. P. (2012). Advantages of Monte Carlo confidence intervals for indirect effects. Communication Methods and Measures, 6, 77–98.

    Article  Google Scholar 

  • Preacher, K. J., Zhang, Z., & Zyphur, M. J. (2011). Alternative methods for assessing mediation in multilevel data: The advantages of multilevel SEM. Structural Equation Modeling, 18, 161-182.

    Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.

    Google Scholar 

  • Raes, F., Ewulf, D., Van Heeringen, C., & Williams, J. M. G. (2009). Mindfulness and reduced cognitive reactivity to sad mood: Evidence from a correlational study and a non-randomized waiting list controlled study. Behavior Research and Therapy, 47, 623–627.

    Article  Google Scholar 

  • Rust, J., & Golombok, S. (2009). Modern psychometrics (3rd ed.). London, UK: Routledge.

    Google Scholar 

  • Segal, Z. V., Williams, J. M., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York, NY: Guilford.

    Google Scholar 

  • Shahar, B., Britton, W., Sbarra, D., Figueredo, A., & Bootzin, R. (2010). Mechanisms of change of mindfulness-based cognitive therapy for depression: Preliminary evidence from a randomized controlled trial. International Journal of Cognitive Therapy, 3, 402–418.

    Article  Google Scholar 

  • Shapiro, S. L., Oman, D., Thoresen, C. E., Plante, T. G., & Flinders, T. (2008). Cultivating mindfulness: Effects on well-being. Journal of Clinical Psychology, 64, 840–862.

    Article  PubMed  Google Scholar 

  • Smith, G. T., Combs, J. L., & Pearson, C. M. (2012). Brief instruments and short forms. In H. Cooper (Ed.), The handbook of research methods in psychology (pp. 395–409). Washington, DC: American Psychological Association.

    Google Scholar 

  • Smith, G. T., Fischer, S., & Fister, S. M. (2003). Incremental validity principles in test construction. Psychological Assessment, 15, 467–477.

    Article  PubMed  Google Scholar 

  • Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. In S. Leinhardt (Ed.), Sociological methodology (pp. 290–312). Washington, DC: American Sociological Association.

    Google Scholar 

  • Tasca, G. A., & Gallop, R. (2009). Multilevel modeling of longitudinal data for psychotherapy researchers: I. The basics. Psychotherapy Research, 19, 429–437.

    Article  PubMed  Google Scholar 

  • Tasca, G. A., Illing, V., Joyce, A. S., & Ogrodniczuk. (2009). Three-level multilevel group models for nested change data: A guide for group treatment researchers. Psychotherapy Research, 19, 453–461.

    Article  PubMed  Google Scholar 

  • Tofighi, D., & MacKinnon, D. P. (2011). RMediation: An R package for mediation analysis confidence intervals. Behavior Research Methods, 43, 692–700.

    Article  PubMed Central  PubMed  Google Scholar 

  • Vago, D. R., & Silbersweig, D. A. (2012). Self-awareness, self-regulation, and self-transcendence (S-ART): A framework for understanding the neurobiological mechanisms of mindfulness. Frontiers in Human Neuroscience, 6, 296.

    Article  PubMed Central  PubMed  Google Scholar 

  • Van Dam, N. T., Earleywine, M., & Danoff-Burg, S. (2009). Differential item function across meditators and non-meditators on the Five Facet Mindfulness Questionnaire. Personality and Individual Differences, 47(5), 516–521.

    Article  Google Scholar 

  • Van Dam, N. T., Hobkirk, A. L., Danoff-Burg, S., & Earleywine, M. (2012). Mind your words positive and negative items create method effects on the five facet mindfulness questionnaire. Assessment, 19(2), 198–204.

    Article  PubMed  Google Scholar 

  • Walach, H., Buchheld, N., Buttenmuller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring mindfulness—the Freiburg Mindfulness Inventory (FMI). Personality and Individual Differences, 40, 1543–1555.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ruth A. Baer .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Eisenlohr-Moul, T., Peters, J.R., Baer, R.A. (2015). How Do Mindfulness-Based Interventions Work? Strategies for Studying Mechanisms of Change in Clinical Research. In: Ostafin, B., Robinson, M., Meier, B. (eds) Handbook of Mindfulness and Self-Regulation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2263-5_12

Download citation

Publish with us

Policies and ethics