Clinical articleHypothesisThe Role of Mindfulness in Positive Reappraisal
Introduction
Among the many interventions at the forefront of integrative medicine, mindfulness meditation is increasingly well regarded for its therapeutic efficacy in a broad range of illness, conditions, and settings. Although the operationalization of the construct is still under debate in academic circles, simply described, mindfulness is a mode of awareness characterized by a present-centered attention to raw experience liberated from cognitive abstractions and preoccupations.1, 2 Although mindfulness practice is at the heart of ancient Buddhist traditions, and as such has been practiced, analyzed, and debated for centuries, it is only within the past decade that mindfulness has received significant attention in the medical and psychological literatures. Indeed, there is mounting empirical evidence of the role of mindfulness in reducing stress and improving health outcomes across conditions as diverse as anxiety,3 depression,4 anger,5 cancer,6 substance abuse,7 fibromyalgia,8 and even psoriasis.9 Despite growing evidence for the clinical utility of mindfulness, there is considerable debate in scientific circles over its therapeutic mechanism of action.
The practice of mindfulness involves a variety of meditative techniques designed to focus attention on experience in the present moment.10, 11 Although it is sometimes assumed that meditative techniques promote health by triggering a relaxation response,12 criticism has been leveled against the conceptualization of mindfulness practice as merely a relaxation technique.10 Putatively, the process of mindfulness extricates attention from being fixated on evaluative language, enabling nonjudgmental, metacognitive awareness of thoughts and feelings.2, 10 This process is described as involving a shift in cognitive sets, known as decentering—a stepping back from mental experience, which results in the realization that thoughts are veridical.13, 14 How this shift of attentional focus may result in salutogenesis is still unknown. In this paper, we explore a hypothetical mechanism through which mindfulness promotes health via positive reappraisal, a form of meaning-based coping.
Since the work of the great medical sociologist Antonovsky,15 it has been empirically demonstrated that coping with adversity is a critical component of health. Of the many forms of coping outlined by Lazarus and Folkman16 in their seminal transactional theory of stress, the construct of positive reappraisal is especially salient. Positive reappraisal, a form of meaning-based coping, is the adaptive process by which stressful events are reconstrued as benign, valuable, or beneficial. Research has demonstrated that the ability to find benefit from adversity is associated with improved health outcomes.17, 18, 19 In spite of the known significance of positive reappraisal coping to healing, the literature has largely ignored the question of how mindfulness may leverage this adaptive coping process. In this paper, we propose a hypothetical causal model that delineates the interactional dynamics between mindfulness and positive reappraisal.
Given the relevance of positive reappraisal for health, it behooves the clinician and researcher alike to discover the mechanism by which it operates. How does a person disengage from a previously established stress appraisal to construct a more adaptive appraisal of their circumstances? Here, we propose that the mechanism allowing one to shift from stress appraisals to positive reappraisals involves the metacognitive mode of mindfulness, a mode in which thoughts are experienced as transient, psychological events rather than reflections of absolute reality. The practice of mindfulness may facilitate and strengthen this capacity for positive reappraisal.
To understand the role of mindfulness in positive reappraisal, we first review the concept of positive reappraisal in transactional stress and coping theory. Next, we review research related to mindfulness and cognitive reappraisal, based on a targeted search and focused analysis of extant research. We then identify traditional Buddhist views that implicate the role of mindfulness in positive reappraisal. Based on this conceptual review, we detail the hypothesized central role of mindfulness in the reappraisal process, presenting a causal model explicating the proposed mechanism. Finally, we discuss implications for clinical practice, suggesting a potential leverage point, a linchpin with which mindfulness-based integrative medicine interventions can be designed to support coping processes.
Section snippets
Positive Reappraisal As an Adaptive Coping Process
Lazarus and Folkman16 identified appraisal as central to the stress process. When a given stimulus is initially appraised as challenging, harmful, or threatening, an activation of physiological systems involved in the stress response co-occurs with a subjective experience of distress. For example, one such biological stress pathway involves the stimulation of the hypothalamic-pituitary-adrenal axis leading to elevated secretion of cortisol.20 Primary appraisal of the stimulus is then followed
Discussion
The mindful coping model is designed to elucidate a mechanism central to emotionally focused coping processes. In so doing, it provides a conceptual map to guide future research on the underpinnings of positive reappraisal. Additionally, this model provides both rationale and impetus for viewing mindfulness as a fulcrum for clinical interventions that, when leveraged, can bolster the meaning-based coping of clients under duress.
Clinical interventions can be developed to utilize the mindfulness
Acknowledgment
We thank Drs Matthew Howard and Gary Bowen from the University of North Carolina at Chapel Hill, School of Social Work, for their helpful reviews of this manuscript.
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The development of this manuscript was supported by a grant to E.G. from the George H. Hitchings Fund for Health Research and Science Education of the Triangle Community Foundation, Durham, NC.