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indfulness is linked with a set of crosscultural principles and practices originating in Asia more than 2,500 years
ago that have parallel manifestations in numerous
cultures around the world. With regard to its current academic usage, mindfulness refers to a psychological phenomenon that is now being studied for
its relevance to mental and physical health in elds
such as medicine, psychology, and neuroscience.
Across these elds, there is a growing body of literature that attests to the efcacy of mindfulness-based
therapies for a wide range of biobehavioral disorders.
According to a search of PubMed and CRISP databases conducted on October 4, 2009, there were
1,614 peer-reviewed journal articles on mindfulness
published in the scientic literature and 320 research
grants on mindfulness funded by the National Institutes of Health between 1998 and 2009. Indeed,
there is mounting empirical evidence of the role of
mindfulness in reducing stress and improving clinical
outcomes across diverse conditions such as depression (Teasdale et al., 2002), relationship difculties
(Carson, Carson, Gil, & Baucom, 2004), irritable
bowel syndrome (Gaylord et al., 2011), criminal recidivism (Himelstein, 2011), chronic pain
(Rosenzweig et al., 2010), and addiction (Bowen
et al., 2006; Garland, Gaylord, Boettiger, & Howard,
doi: 10.1093/swr/svt038
2010). Consequently, mindfulness-based interventions are becoming well-regarded for their therapeutic promise, as evidenced by recent publications in
mainstream, respected academic outlets, such as the
Journal of the American Medical Association (for example, Ludwig & Kabat-Zinn, 2008).
Given this burgeoning interest, mindfulnessbased interventions are attracting the attention of
clinical social workers who are increasingly implementing these treatments across diverse domains of
practice. Concomitantly, research on mindfulness
is now falling under the purview of social work
scholars, many of whom seek to determine the
comparative effectiveness of mindfulness-based
interventions and apply the construct of mindfulness to theories and models of social work practice.
In response to the growing interest in mindfulness
within academic social work, this article outlines
six conceptual and methodological recommendations for the conduct of future empirical research
on mindfulness.
INCREASE PRECISION IN
OPERATIONALIZATION OF THE CONSTRUCT
OF MINDFULNESS
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step. Without such precision, empirical investigations of putatively identical phenomena may result
in widely divergent correlations between constructs of interest and inconsistent clinical outcomes
across studies. Ultimately, imprecise operationalization of constructs presents a severe threat to validity
that can undermine the quality of otherwise
well-designed research studies (Shadish, Cook, &
Campbell, 2002). Mindfulness research within and
outside of social work has been rife with this problem. An examination of Hicks (2009) edited volume Mindfulness and Social Work clearly demonstrates
this issue. According to Hick, mindfulness is an
orientation to our everyday experiences ( p. 1); to
others in the edited volume, it is a specic and
effective method of focusing the mind on the essence of experience ( p. 45), a way to mediate the
development of professional self-concept ( p. 93),
an approach for increasing awareness ( p. 125),
an approach for performing all activities with full
awareness ( p. 154), and even a necessary condition for an activist to become mature in her passion
and mission to ght for justice (p. 178). This lack
of conceptual clarity should be rectied and a uniform, coherent set of denitions established, if mindfulness research within social work is to advance.
To that end, the following operationalizations of
mindfulness are offered. First, mindfulness is a state,
a naturalistic mindset characterized by an attentive
and nonjudgmental metacognitive monitoring of
moment-by-moment cognition, emotion, perception, and sensation without xation on thoughts of
past and future (Garland, 2007; Lutz, Slagter,
Dunne, & Davidson, 2008). Mindfulness is metacognitive in the sense that it involves a meta-level
of awareness that monitors the content of consciousness while reecting back upon the process
of consciousness itself (Nelson, Stuart, Howard, &
Crowley, 1999). Mindfulness is naturalistic in that
it is a basic and inherent capacity of the human
mind, although people differ in their ability and
willingness to actualize this state (Brown, Ryan, &
Creswell, 2007; Goldstein, 2002).
Second, mindfulness is a practice (or, more accurately, a set of practices) designed to evoke and foster the state of mindfulness. The practice of
mindfulness involves repeated placement of attention onto an object while alternately acknowledging and letting go of distracting thoughts and
emotions. Objects of mindfulness practice can
include the sensation of breathing; the sensation of
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walking; interoceptive (Craig, 2003) and proprioceptive (Brodal, 2004) feedback about the bodys
internal state, movement, and position; visual stimuli such as a candle ame or running water; mental
contents such as thoughts or feelings; or the quality
of awareness itself (Lutz et al., 2008). These practices are taught and trained in mindfulness-based
interventions.
Third, mindfulness is a trait or disposition that
may be developed over time through the repeated
practice of engaging in the state of mindfulness.
This trait may be characterized as the propensity
toward exhibiting nonjudgmental, nonreactive
awareness of ones thoughts, emotions, experiences, and actions in everyday life (Baer, Smith,
Hopkins, Krietemeyer, & Toney, 2006). As a trait,
mindfulness is roughly normally distributed (Walach,
Buchheld, Buttenmllerc, Kleinknechtc, & Schmidta,
2006). People vary in the extent to which they
exhibit mindful dispositions, yet this dispositionality can be strengthened through training. People
who participate in mindfulness-based interventions
evidence increases in trait mindfulness, which mediates the effects of training on clinical outcomes
(Carmody & Baer, 2008).
Thus, integral to mindfulness is the notion of
state by trait interaction, that is, recurrent activation of
the mindful state via mindfulness practices leaves
lasting traces that may accrue into durable changes
in trait mindfulness (Garland, Fredrickson, et al.,
2010), possibly mediated through neuroplasticity
and experience-dependent alterations in gene
expression (Garland & Howard, 2009). Indeed,
recent research suggests that mindfulness practice
can lead to increases in grey matter density in parts
of the brain that subserve emotion regulation,
learning, memory, and the ability to shift ones
perspective (Holzel et al., 2011). More research is
needed to determine whether such neurobiological changes index the development of trait mindfulness over time resulting from mindfulness
training.
USE RANDOMIZED CONTROLLED DESIGNS
WHEREVER POSSIBLE
A large number of social work studies use nonexperimental and quasi-experimental research designs
that are subject to severe threats to internal validity
(Shadish et al., 2002). Despite the presence of these
threats, authors often overstep the data by making
causal claims from what are, at best, descriptive or
based treatments for cocaine addiction is inherently awed, as it suggests the treatment of
interest or preference and potentially introduces
expectancy effects that may confound study results. In contrast, research advertisements should
conceal the identity of the experimental and
control treatments. For instance, the same yer
would minimize expectancy effects by stating,
We are conducting research to compare the effectiveness of two forms of treatment for cocaine
addiction: a mindfulness-based treatment and a
support group.
Moreover, the presence of signicant main
effects of time on clinical outcome variables suggests that the control condition may have been
therapeutically active; yet, the presence of a signicant Treatment Time interaction term in the
hypothesized direction indicates that the experimental mindfulness treatment led to signicantly
larger therapeutic change over time than the control treatment. For example, in a randomized controlled trial of psychosocial treatments for irritable
bowel syndrome, Gaylord et al. (2011) found that
participants in a mindfulness training intervention
and a conventional support group experienced signicant reductions in abdominal pain; yet, relative
to those in the support group, participants in the
mindfulness training intervention experienced signicantly greater reductions over the course of
training.
The use of credible, therapeutically active control groups may eliminate confounds introduced
by expectancy and placebo effects as well as
other nonspecic therapeutic factors such as attention by a caring professional, group dynamics, social support, empathy, and the therapeutic alliance
(Castonguay, Goldfried, Wiser, Raue, & Hayes,
1996; Duncan, Miller, & Sparks, 2007). When a
study of a mindfulness-based intervention identies signicant clinical outcomes within the context of this rigorous research design, it may provide
evidence against the Dodo bird verdict (for a review, see Budd & Hughes, 2009). However, it should
be noted that a study comparing a mindfulness-based
intervention to a no-treatment control is asking a
substantively different question than a study comparing a mindfulness-based intervention to an
active placebo control condition. In the former
case, the design allows one to measure the efcacy
of participation in a mindfulness-based intervention; whereas in the latter case, the design allows
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Table 1: Select Key Studies Representing the Broad Scope of Research on Mindfulness as a State, Trait, and Practice
Study
Sample
Design
Operationalization of Mindfulness
or Related Phenomena
Pertinent Results
Bowen et al.
(2009)
Carmody &
Baer (2008)
Feldman,
Greeson, &
Senville
(2010)
State mindfulness (decentering) assessed by MT participants reported significantly greater state mindfulness
(decentering) relative to the other two conditions. Relative to the
the TMS; frequency of or reactivity to
other conditions, a 15-minute session of MT reduced negative
repetitive thoughts
reactions to repetitive thoughts.
Garland,
Gaylord,
et al. (2010)
Gaylord et al.
(2011)
RCT of MT versus a
support group
Holzel et al.
(2011)
Quasi-experiment
comparing MBSR to
wait-list control group
Kuyken et al.
(2010)
Teasdale et al.
(2002)
Random assignment to 15
minutes of MT, LKM,
or PMR
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Notes: MBRP = mindfulness-based relapse prevention; AAQ = Acceptance and Action Questionnaire (Hayes et al., 2004); FFMQ = Five-Facet Mindfulness Questionnaire (Baer et al., 2006); LKM = loving-kindness meditation; KIMS = Kentucky Inventory of Mindfulness
Skills (Baer, Smith, & Allen, 2004); MACAM = Measure of Awareness and Coping in Autobiographical Memory (Moore, Hayhurst, & Teasdale, 1996); MBCT = mindfulness-based cognitive therapy; MBSR = mindfulness-based stress reduction;
MORE = mindfulness-oriented recovery enhancement; MT = mindfulness training; PMR = progressive muscle relaxation; RCT = randomized controlled trial; SCS = Self-Compassion Scale (Neff, 2003); TAU = treatment as usual; TMS = Toronto Mindfulness Scale (Lau et al.,
2006); WBSI = White Bear Suppression Inventory (Wegner & Zanakos, 1994).
a
These mediational data are presented in Garland, Gaylord, Palsson et al. (2012).
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assess whether changes in more proximal psychological variables mediate the effect of mindfulness
practice on these distal clinical outcomes.
USE A MIXED-METHODS APPROACH
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