What are the Active Ingredients of Mindfulness-based Interventions?

What are the Active Ingredients of Mindfulness-based Interventions?

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Mindfulness-based interventions typically comprise numerous elements, including some or all of the following: guided mindfulness exercises, guided loving-kindness and compassion meditation exercises, group discussion, psycho-education (sometimes in the style of a university lecture), yoga, one-to-one discussion with the programme facilitator, a CD of guided meditations to encourage at-home practice, and a full or half-day silent group retreat. Given that each of the above techniques arguably have therapeutic utility in their own right, ascertaining why MBIs are effective is problematic because they have numerous ‘active ingredients’.

Not controlling for other active ingredients is a common limitation of MBI intervention studies. Indeed, although scientific evidence demonstrates that certain MBIs are equally or more effective than other treatments for improving specific health conditions, it is currently unclear whether it is mindfulness, or mindfulness in combination with other therapeutic techniques, that results in health benefits. One way to overcome this methodological limitation is to employ a purpose-designed ‘active’ control condition. This is a control intervention that mirrors the main intervention in terms of its design, but does not include any mindfulness techniques. By conducting a randomised controlled trial that compares the effectiveness of an MBI against a suitably formulated active control intervention, we can determine that superior outcomes in the MBI versus control group are caused by mindfulness.

It could be argued that it doesn’t matter whether it is specifically mindfulness or other intervention components that make MBIs effective. If we are only interested in treatment outcomes and adhere to a ‘what works’ approach to alleviating illness symptoms, then establishing which intervention components are most effective becomes less important. However, from the point of view of advancing scientific understanding of how the human mind reacts to given psychotherapeutic techniques, it is useful to establish which ingredients are most active within a given intervention. Such knowledge can also help to inform the development of more effective and ‘therapeutically streamlined’ MBIs.

When designing an active control intervention for MBI efficacy studies, in addition to matching the design of the target and control interventions (i.e., minus the inclusion of mindfulness techniques), it is also important to match the ‘competency’ of the instructor or instructors delivering the two interventions. For example, a number of meditation intervention studies employing an active control condition have used an experienced clinician and meditation teacher to deliver the MBI, whilst leaving a relatively inexperienced student to administer the control intervention. Clearly, such an approach can introduce bias and weaken the strength of the evidence from MBI studies.

In order to overcome the above methodological limitation, in a recent randomised controlled trial that we conducted, the study was designed such that the same instructor delivered the MBI and comparison intervention. To control for potential bias on the part of the instructor, participants in each intervention condition were asked to rate the instructor’s levels of enthusiasm and preparation. Statistical tests were then performed to determine if there were significant differences between how participants from the intervention and control group rated the instructor’s performance.

We decided to control for an ‘instructor effect’ because in our opinion, the mindfulness instructor is one of the most active ingredients in MBIs. Part of our research has involved the development and empirical investigation of a ‘second-generation’ of MBI. Second-generation MBIs (such as Meditation Awareness Training) are designed slightly differently compared to ‘first-generation’ MBIs (such as Mindfulness-based Stress Reduction or Mindfulness-based Cognitive Therapy). More specifically, second generation MBIs are overtly spiritual in nature and teach a greater range of meditative techniques. Given that second-generation MBIs comprise different design elements compared to first-generation MBIs, it is reasonable to assume that these two types of MBIs will result in different outcomes. However, despite the design differences between first- and second-generation MBIs, it is our view that if a mindfulness teacher with authentic spiritual realisation was to administer a first-generation MBI, the outcomes would be very similar to them administering a second-generation MBI.

In other words, if the mindfulness teacher is genuinely rooted in the present moment, the specific design of the MBI becomes less important. As we discussed in our post on The Four Types of Psychologist, we would argue that the same principle applies to the majority of psychological therapies. If the clinician knows their own mind, has genuine compassion for the client, and is skilled in helping the client understand their problems, then the choice of therapy becomes less important.

Although preliminary findings (including from some of our own clinical case studies and qualitative studies) support the notion that the mindfulness teacher is one of the (if not the) most important ingredients of MBIs, there is clearly a need for further research investigating how the instructor influences outcomes. However, in the absence of extensive empirical investigation into this subject, we hypothesise that what participants of MBIs need most (and therefore respond best to), is the unconditional love and spiritual wisdom of a teacher who is without a personal agenda, and whose mind is saturated with meditative awareness.

 

Ven. Edo Shonin and Ven. William Van Gordon

Further Reading

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

Chiesa, A. (2013). The difficulty of defining mindfulness: Current thought and critical issues. Mindfulness, 4, 255-268.

Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67, 404-424.

MacCoon, D., Imel, Z., Rosenkranz, M., Sheftel, J., Weng, H., Sullivan, J., . . . Lutz, A. (2012). The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR). Behavior Research and Therapy, 50, 3-12.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N. N., & Griffiths, M. D. (2014). Meditation Awareness Training for work-related wellbeing and job performance: A randomised controlled trial. International Journal of Mental Health and Addiction, 12, 806-823.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015a). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., & Van Gordon, W. (2015). The lineage of mindfulness. Mindfulness, 6, 141-145.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013). Meditation as medication: Are attitudes changing? British Journal of General Practice, 63, 654.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia and New Zealand Journal of Psychiatry, 49, 591-591.

Shonin, E., Van Gordon, W., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015). Buddhist-derived loving-kindness and compassion meditation for the treatment of psychopathology: A systematic review. Mindfulness, 6, 1161-1180.

Shonin, E., & Van Gordon, W. (2013). Searching for the present moment, Mindfulness, 5, 105-107.

How to Tame a Monkey Mind

How to Tame a Monkey Mind

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Within Buddhism, the term ‘monkey mind’ is sometimes used to describe people that have very unsettled minds. If you have a monkey mind, it basically means that just like a naughty monkey, your mind constantly jumps from one thing to another and only very rarely does it actually settle down. People with monkey minds might be engaged in some kind of task or conversation, but they quickly succumb to boredom and their mind begins to wander off again. The monkey mind condition normally becomes apparent to people when they start learning meditation. Indeed, people that are new to meditation frequently experience great difficulty in holding their concentration on a single meditative object (such as the natural flow of their in-breath and out-breath). We are not aware of any empirical research that has attempted to quantify the prevalence of the monkey mind condition, but we would estimate that most people would admit to having experienced monkey-mindedness to a greater or lesser extent.

In general, people with a more severe form of monkey-mindedness are quite easy to spot because in addition to being mentally restless, they are invariably also very physically restless. Of course, there can be many reasons – including medical ones – that may influence the degree of physical unrest that a person exhibits. However, generally speaking and based on our experience, if a person finds it difficult to sit still and always has to be doing something, then this is a sign that they may be afflicted by monkey-mindedness. Another good indicator of monkey-mindedness is when an individual is following a certain line of dialogue or conversation and they suddenly go off on tangents and introduce completely-unrelated topics. In fact, we encounter quite a number of people that can thread together what seems to be an endless string of completely-unrelated topics and hold (what they deem to be) a ‘conversation’ for hours on end. Perhaps the monkey in the mind of people like this is bigger than the average-sized monkey or perhaps it is just particularly naughty and restless – who knows?

Although monkey-mindedness often reveals itself through an individual’s physical demeanour and comportment, some people try to conceal their monkey mind. For example, as part of our vocation as Buddhist monks, we have been present at or facilitated a large number of meditation retreats, and as with most of life’s pursuits, there is a tendency for people at meditation retreats to try to give the impression that they are very experienced and/or are much more accomplished than everybody else. You would probably be surprised at the lengths that some people go to in order to convince others that they are a ‘serious’ meditator. Indeed, some people sit in what they believe is meditation for hours on end without flinching or moving a muscle, and whilst keeping a very solemn expression on their face. For people who are new to meditation, seeing others behave like this can actually be quite intimidating – we’re not sure that it creates a hostile environment but it certainly doesn’t help people to feel welcome and at ease.

Despite their attempts to convince people otherwise, you only need to observe these ‘serious meditators’ when they get up and leave the meditation hall to see that their mind is far from disciplined and serene. Because such people are more interested in giving the impression of practising meditation rather than actually practising it, then it doesn’t take long before the ego-monkey in their mind reveals itself and does or says something that is selfish and/or hurtful to others. In fact, on several separate occasions, we have observed a meditator sitting very seriously, but due to trying to supress or ignore their monkey mind, they allow psychological pressure to build-up. The next thing that happens is they suddenly can’t take it anymore and they end up rushing out of the meditation hall.

The wisdom and lesson that can be learned from the above example of the overly-serious meditator is that if we try to ignore or supress the monkey mind, it can lead to both internal and external conflict. The same thing happens if we are too rigid and serious in our efforts to tame the monkey within. In other words, in order to begin taming the monkey mind, in addition to a certain degree of meditative-technical knowhow, we need a great deal of patience, gentleness, perseverance, and a good sense of humour.

If we understand that on the one hand, taming the monkey mind requires lots of effort and is arguably the most important thing we will ever do in our lives, but on the other hand personal and spiritual growth takes time and cannot be forced, then we create the optimum frame of mind for enjoying the process of transforming unwholesome habits and for progressing along the path of awareness. In order to tame the monkey mind, we need to become aware of its undisciplined nature but in a manner that keeps things light, spacious, and airy. As we discussed in our post on ‘the absorbing mind’, the simple act of observing and becoming aware of our thoughts and mental processes helps to objectify them and to loosen their hold over us. However, if we try to watch our thoughts and feelings too intensely then despite our efforts to do the opposite, we end up giving them too much power and importance.

Therefore, when we practice awareness of our thoughts and of our mental processes, we should do so with a very big and generous mind. This means that we accept the mind as it is and that we don’t try to manipulate it. If the mind is particularly wild and out of control that’s absolutely fine – all we do in this situation is take the unruly mind itself as the object of our awareness. In effect, what we are doing is setting the mind free within the field of our awareness. Because we are not holding onto the mind or offering it resistance by trying to keep it under control, it has no alternative but to begin to calm and settle. Believe it or not, attempting to modify the mind actually runs contrary to the general principle of meditation which is that tranquillity and wisdom are naturally present in the mind and will arise of their own accord when the correct conditions come about. One of these ‘correct conditions’ is simply observing and nourishing the mind through meditative awareness. A metaphor that we have used previously to help explain this principle is that of a garden fish pond – every time the garden pond is stirred or interfered with, the water becomes muddy and unsettled. However, if a person sits quietly next to the pond and simply observes it, the water becomes perfectly still and clear again.

The monkey mind will remain a monkey mind for as long as we choose not to tame it. We might decide that we don’t have a monkey mind or that we do have one but that it doesn’t need to be changed. However, if we are being truthful with ourselves and if we examine the mind closely, unless we are already very spiritually enlightened, then we are likely to see that it is only very rarely (if at all) that we experience true peace of mind. Indeed, irrespective of whether or not we are aware of the wild nature of our minds, having a mind that is always racing around – constantly jumping to and fro between the past and the future – eventually causes us to become physically, mentally, and spiritually exhausted. In fact, it is our personal view that a lot of mental health problems such as anxiety, stress, and depression arise because people have very unruly minds and are without the knowledge of how to properly tend to their thoughts and feelings. However, it is also our view that by practising full awareness of all of our thoughts and mind movements, we can begin to take care of our monkey mind until it gradually learns to sit in perfect stillness and quiet.

Ven. Edo Shonin & Ven. William Van Gordon