Operationalising Mindfulness. Recently, mindfulness meditation has been demonstrated to have clinical efficacy, both incorporated into existing psychological treatment approaches and as an intervention in its own right (Baer, 2003; Bishop et al., 2004; Brown & Ryan, 2004; Carlson, Speca, Patel & Goodey, 2003; Davidson et al., 2003; Grossman, Niemann, Schmidt & Walach, 2004; Hayes & Shenk, 2004; Heidenreich & Michalak, 2003; Lowenstein, 2002; Ma & Teasdale, 2004; Mason & Hargreaves, 2001; Roth & Stanley, 2002; Shapiro, Schwartz & Bonner, 1998; Smith, Compton & West, 1995; Williams, Teasdale, Segal & Soulsby, 2000). It has not, however, been consistently operationalised, and various descriptions abound in the literature (e.g. Bishop et al., 2004; Hayes & Feldman, 2004; Baer, 2003; Brown & Ryan, 2003; Hayes, 2003; Roemer & Orsillo, 2003; Bishop, 2002; Kabat-Zinn, 1990, 2003). This perhaps reflects the intrinsically problematic nature of defining such an experience-based practice, prescientific concept (Hayes & Shenk, 2004). Most, however, seem to emphasise two main points. The first is that a mindful state is characterized by full attention to, and awareness of, the internal and external sensory and cognitive experience of the present moment. Second, this awareness is employed in such a way that whatever arises is simply acknowledged and examined, without any judgment, elaboration, or reaction . It thus appears to incorporate elements of both attention-regulation (executive function) and an orientation to experience characterized by openness, acceptance, and nonjudgmentalism (Bishop et al., 2004; Brown & Ryan, 2004; Hayes & Shenk, 2004; Bishop, 2002).
In this way, it is prereflexive, meaning that it is perceptual rather than evaluative, operating on rather than within thought (Bishop et al., 2004; Brown & Ryan, 2003). This is salient, as reflexive consciousness (e.g. self-consciousness and rumination) has been demonstrated to have negative consequences for psychological wellbeing, whereas prereflexive consciousness has been suggested to predict increased wellbeing and decreased cognitive and emotional disturbance (Brown & Ryan, 2003).
In fact, this is the fundamental difference between mindfulness-based interventions and standard cognitive-behavioural therapy (CBT) approaches (Roemer & Orsillo, 2002). While both seek to develop increased awareness of cognitive and physical states through a process of introspection and self-observation, mindfulness-based approaches do not emphasise classification of experiences as good/bad, true/false, mine/not mine (Shapiro, Schwartz & Bonner, 1998). Rather, such experiences are simply acknowledged nonjudgmentally. In this way, stress may come to be viewed as a challenge rather than a threat. There is therefore no sense of seeking to eradicate negative mindstates. Indeed, there is a predominant quality of "nonstriving", whereby there is no clear goal which is to be achieved (Baer, 2003).
There is disagreement as to whether mindfulness represents a distinct construct (Brown & Ryan, 2003) or merely a quality of consciousness that spans and incorporates various other constructs. Brown & Ryan (2003) have developed a measure of mindfulness, the Mindful Attention Awareness Scale (MAAS), which they suggest appears to tap a distinct construct. They suggest the scale differentiates mindfulness practitioners from others, and is associated with enhanced self-awareness and psychological wellbeing, unique from other psychological traits and characteristics. However, Bishop (2002) argues that there is little evidence to support this, suggesting that construct validity for mindfulness necessitates further exploration of the relationship between mindfulness training and enhanced cognitive performance, especially on tasks involving sustained attention and switching.
Brown & Ryan (2003) also argue that the capacity to attend is universal, although differs in extent between people, as it can be enhanced or compromised by a variety of factors. They thus distinguish between trait (dispositional) and state mindfulness, suggesting that trait mindfulness predicts autonomous activity in everyday life, while state mindfulness is associated with momentary positive affect and experience. The effects of each are proposed to be independent, although they suggest that state mindfulness is more likely among those who exhibit the trait.
This is an important issue. While both trait and state mindfulness "predict self-regulated behaviour and positive emotional states" (Brown & Ryan, 2003, p.822), it is critical to determine what role each of these elements plays, if we are to develop programs which effect lasting changes. Research does suggest enduring benefits of mindfulness training, at least for a period of months (Baer, 2003; Davidson et al., 2003; Miller, Fletcher & Kabat-Zinn, 1995), but it is unclear whether this reflects trait modification or temporal proximity effects (Brown & Ryan, 2003). Brown & Ryan posit an inverse relationship between mindfulness and mood disturbance both before and after mindfulness training, suggesting the primacy of trait mindfulness, but they also acknowledge that increases in state mindfulness generated by the training amplified this relationship. Further, Bishop and colleagues (2004) suggest that mindfulness persists only so long as the particular, unique type of attention outlined above is brought to bear. Thus, a study that examines directly whether trait mindfulness can be changed is timely, as if this is the case, numerous possibilities arise for more effective use of mindfulness as an intervention. In order to determine this, however, the mechanisms underlying mindfulness need to be better understood.
Proposed Mechanisms. Arguably as a result of insufficient operationalisation and paucity of adequate measurement tools, mindfulness has been confounded with various other concepts and constructs, such as acceptance, cognitive defusion, exposure, acceptance, and relaxation (Dimidjian & Linehan, 2003; Hayes, 2003). The most commonly cited of these is relaxation (Dunn, Hartigan & Mikulas, 1999), although it has been suggested that this is, at most, a beneficial side-effect of mindfulness practice, rather than a causal mechanism (Baer, 2003).
Another proposed mechanism is the erosion of the use of literal, evaluative language (Hayes & Shenk, 2004; Hayes, 2003). Rather than evaluating our cognitive and emotional experiences, mindfulness teaches us to simply acknowledge them. Doing so circumvents the usual cognitive defenses that arise and motivate us to either avoid or seek to prolong such experiences, resulting in increased range and flexibility of actions (Hayes, 2003). This has been termed cognitive flexibility (Roemer & Orsillo, 2003).
Relatedly, mindfulness training may facilitate metacognitive insight (Bishop et al., 2004; Mason & Hargreaves, 2001; Teasdale, 1999; Teasdale et al., 1995), a qualitative "decentring" from viewing thoughts as direct representations of reality to understanding them simply as transient mental events. This introduces a sort of "distance" between us and our problematic thoughts and emotions, allowing us to address them consciously, rather than merely reacting to them.
This quality of nonreactivity allows for the operation of two further mechanisms, exposure (Kabat-Zinn, 1982; Kabat-Zinn et al., 1992) and acceptance (Brown & Ryan, 2004; Hayes, 1994; Roemer & Orsillo, 2002; Teasdale, Segal & Williams, 1995). This may lead to reduced reactivity to negative emotional states such as anxiety (Baer, 2003), allowing exposure to thoughts and emotions that would normally engender defensive reactions. It also avoids the negative affect which inherently arises from attempts to retain positive emotions and cognitions, which are by nature ephemeral. This deepens our self-knowledge, operating in much the same way as standard cognitive-behavioural approaches, although without the emphasis on changing "dysfunctional" patterns of cognition. In contrast, mindfulness training saliences the relationship between acceptance and change, empowering the practitioner to balance each of these qualities. It should be noted, however, that exposure and acceptance themselves may represent distinct constructs, and may be confounded with mindfulness (Hayes, 2003).
Training in mindfulness may also initiate a shift away from goal-based processing, resulting in reduced rumination and further openness to experience (Bishop et al., 2004; Teasdale, Segal & Williams, 2003a). However, why and how this occurs is not well understood. More research is needed in the area, as there is an inherent danger of therapists who use mindfulness-based techniques misunderstanding this distinction and delivering mindfulness training in a goal-oriented way (Teasdale, Segal & Williams, 2003).
Finally, the emphasis of mindfulness training on focusing on the present moment may develop control of attention (Baer, 2003), or executive function. This enhances capacity for sustained attention, attention switching, and inhibition of elaborative processing (Bishop et al., 2004), thereby increasing our mastery over the content of our thoughts and actions. Working synergistically with the mechanisms outlined above, this amplifies our ability to self-regulate (Shapiro & Schwartz, 2000), allowing us to redirect our attention from rumination and depressogenic thoughts back to the experience of the present moment (Teasdale, 1999; Teasdale & Segal, 2003; Teasdale, Segal & Williams, 1995), thus decreasing negative affect and improving psychological health (Davidson et al, 2003; Shapiro, Schwartz & Bonner, 1998).