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.

A Second Generation of Mindfulness-based Intervention

A Second Generation of Mindfulness-based Intervention

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In one of our research papers that was published this summer in the journal Mindfulness, we identified and discussed a recent development in mindfulness research and practice. Until a few years ago, mindfulness research within psychology has primarily focussed on what have been termed First Generation Mindfulness-Based Interventions (FG-MBIs). FG-MBIs refer to interventions such as Mindfulness-Based Stress Reduction (MBSR) developed by Kabat-Zinn in the late 1970s and Mindfulness-Based Cognitive Therapy (MBCT) developed by Segal, Williams, and Teasdale in 2002. According to Professor Nirbhay Singh and colleagues, one of the primary purposes and achievements of FG-MBIs has been gaining acceptance of mindfulness within Western clinical and scientific domains.

However, due to the speed at which mindfulness has been integrated into western research and public healthcare settings, concerns have been raised by scientists and Buddhist teachers regarding the ‘authenticity’ of FG-MBIs and whether they actually teach mindfulness in a manner that still bears any resemblance to the traditional Buddhist model. These concerns do not detract from the fact that there is a growing evidence-base that supports the efficacy of FGMBIs as clinical and behavioural interventions, but they give rise to a number of questions that have important implications for mindfulness research and practice:

  1. If mindfulness is efficacious when it is taught in isolation of many of the practices and principles that are traditionally deemed to make it effective, then how much more effective will it be when taught in a manner that includes and embodies these supporting elements?
  2. Is it ethically correct to inform service users and members of the public that they are receiving training in a method that is grounded in Buddhist practice (a claim often made about FG-MBIs), when in fact this is not the case?
  3. Is it essential to “de-spiritualise” psychological interventions before they can be used in clinical contexts, or – based on a “what-works approach” – can interventions that are openly spiritual in nature be considered as viable and mainstream public healthcare treatments?

In an attempt to overcome some of the above issues concerning FG-MBIs, efforts have been made in recent years to formulate and empirically evaluate a second generation of mindfulness-based interventions. Second Generation Mindfulness-based Interventions (SG-MBIs) are still intended to be used in public healthcare contexts (i.e., they are still secular in nature)  but – as explained in the following quote from our recently published Mindfulness paper – they are openly spiritual in nature and are more traditional in the manner in which they construct and teach mindfulness:

Due to the suggestion that some individuals may prefer to be trained in a version of mindfulness that more closely resembles a traditional Buddhist approach, recent years have witnessed the development and early-stage evaluation of several Second Generation Mindfulness-Based Interventions (SG-MBIs) … Although SG-MBIs still follow a secular format that is suitable for delivery within Western applied settings, they are overtly spiritual in aspect and teach mindfulness within a practice infrastructure that integrates what would traditionally be deemed as prerequisites for effective spiritual and meditative development. At the most basic (but by no means the least profound) level, such prerequisites include each element of the Noble Eightfold Path. The Noble Eightfold Path comprises each of the three quintessential Buddhist teaching and practice principles of (i) wisdom (i.e., right view, right intention), (ii) ethical conduct (i.e., right speech, right action, right livelihood), and (iii) meditation (i.e., right effort, right mindfulness, right concentration). Each of these three fundamental elements (Sanskrit: trishiksha – the three trainings) must be present in any path of practice that claims to expound or be grounded in authentic Buddhadharma and they apply to (and form the basis of) the Fundamental or Theravada vehicle just as much as they do the Mahayana and Vajrayana Buddhist vehicles. Thus, for mindfulness practice to be effective, it must be taught as part of a rounded spiritual path and it must be taught by a spiritual guide that can transmit the teachings in an authentic manner.

The development and empirical evaluation of a second generation of mindfulness-based intervention appears to represent an emerging trend in mindfulness research. Outcomes from our own research work with the eight-week SG-MBI known as Meditation Awareness Training (MAT) suggest that SG-MBIs may have applications in the treatment of (i) workaholism, (ii) work-related stress, (iii) stress, (iv) anxiety, (v) depression, (vi) schizophrenia, and (vii) pathological gambling. Recent MAT studies that we have conducted have also demonstrated that SG-MBIs can help to improve work effectiveness, decision-making competency, and leadership/management skills more generally. SG-MBI studies by other researchers also indicate a range of clinical and non-clinical applications for SG-MBIs. For example, studies led by Professor Nirbhay Singh indicate that SG-MBIs may have utility as (i) a smoking cessation program for individuals with mild intellectual disabilities, (ii) an anger regulation method for individuals with schizophrenia, and (iii) a training and support program for parents in order to reduce the aggressive and disruptive behaviour of their children/adolescents. However, it needs to be remembered that research into SG-MBIs is still at a very early stage and so although the abovementioned outcomes are promising, further empirical investigation is obviously required. Furthermore, it is our view that rather than directly compete with FG-MBIs, SG-MBIs simply provide an alternative approach to practising mindfulness that – for some individuals – may be more appealing.

Please note: This article provides a summary of, and is adapted from, a discussion that first appeared in a paper we published in the journal Mindfulness.

 Ven Edo Shonin & Ven William Van Gordon

Further Reading

Carrette, J., & King, R. (2005). Selling spirituality: The silent takeover of religion. New York: Routledge.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.

McWilliams, S. A. (2014). Foundations of Mindfulness and Contemplation: Traditional and Contemporary Perspectives. International Journal of Mental Health and Addiction, 12, 116-128.

Rosch, E. (2007). More than mindfulness: when you have a tiger by the tail, let it eat you. Psychological Inquiry, 18, 258-264.

*Shonin, E., & Van Gordon, W. (2014) Manager’s experiences of Meditation Awareness Training. Mindfulness, DOI: 10.1007/s12671-014-0334-y. [Source Article].

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013a). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 1-4. DOI: 10.3389/fpsyg.2013.00194.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014c). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N., & Griffiths, M. D. (2014d). Meditation Awareness Training for work-related wellbeing and job performance: A randomized controlled trial. International Journal of Mental Health and Addiction,  DOI 10.1007/s11469-014-9513-2.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014e). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M. D. (2013). Meditation Awareness Training (MAT) for improved psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 53, 849-863.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J. Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31, 749-771.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazia, B. T., Singh, A. D. A., Singh, A. N. A., & Singh, J. (2013). A mindfulness-based smoking cessation program for individuals with mild intellectual disability. Mindfulness, 4, 148-157.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., & Singh, J. (2014a). Mindfulness-Based Positive Behavior Support (MBPBS) for mothers of adolescents with autism spectrum disorders: Effects on adolescents’ behavior and parental stress. Mindfulness, DOI: 10.1007/s12671-014-0321-3.

Singh, N. N., Lancioni, G. E., Myers, R. E., Karazsia, B. T., Winton, A. S. W., & Singh, J. (2014b). A randomized controlled trial of a mindfulness-based smoking cessation program for individuals with mild intellectual disability. International Journal of Mental Health and Addiction, 12, 153-168.

Singh, N. N., Lancioni, G. E., Karazsia, B. T., Winton, A. S. W., Singh, J., & Wahler, R. G. (2014c). Shenpa and compassionate abiding: Mindfulness-based practices for anger and aggression by individuals with schizophrenia. International Journal of Mental Health and Addiction, 12, 138-152.

Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M. D. (2014b). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 5, 381-391.

Van Gordon, W., Shonin, E., Zangeneh, M., & Griffiths, M. D. (2014). Work-related mental health and job performance: Can mindfulness help? International Journal of Mental Health and Addiction, 12, 129-137.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2015). Mindfulness and the Four Noble Truths. In: Shonin, E., Van Gordon W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness. New York: Springer.

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

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.

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

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

Una nuova generazione di interventi basati sulla Mindfulness

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In uno dei nostri documenti di ricerca che è stata pubblicata questa estate sulla rivista academica Mindfulness, abbiamo identificato e discusso un recente sviluppo nella ricerca e nella pratica della mindfulness Fino a pochi anni fa, la ricerca di mindfulness all’interno della psicologia si è concentrata principalmente su ciò che sono stati definiti Interventi di Prima Generazione cioè First Generation Mindfulness-Based Interventions (FG-MBIs). FG-MBI si riferisce a interventi quali Mindfulness-Based Stress Reduction (MBSR) sviluppato da Kabat-Zinn alla fine del 1970 e Mindfulness-based Cognitive Therapy (MBCT) sviluppato da Segal, Williams e Teasdale nel 2002. Secondo il professor Nirbhay Singh e colleghi, uno degli scopi e conquisti principali di FG-MBI è stato di ottenere l’accettazione della mindfulness all’interno dei domini clinici e scientifici occidentali.

Tuttavia, a causa della velocità alla quale la mindfulness è stato integrato nella ricerca occidentale e nelle strutture sanitarie pubbliche, le preoccupazioni sono state sollevate da scienziati e insegnanti buddisti per quanto riguarda il ‘autenticità’ di FG-MBI e se insegnano effettivamente mindfulness in un modo che ancora oggi porta qualsiasi somiglianza con il modello tradizionale buddista. Queste preoccupazioni non toglie il fatto che vi è una crescente evidenza empirica che sostiene l’efficacia di FGMBIs come interventi clinici e comportamentali, ma danno luogo a una serie di domande che hanno importanti implicazioni per la ricerca e la pratica della mindfulness:

  1. Se la mindfulness è efficace quando si è insegnato in isolamento di molte delle pratiche e principi che sono tradizionalmente considerati a renderla efficace, allora quanto più efficace ne sarà quando insegnato in un modo che include e incorpora questi elementi di supporto?
  2. È eticamente corretto a informare gli utenti del servizio e membri del pubblico che essi ricevono una formazione in un metodo che è radicato nella pratica buddista (un’affermazione spesso fatta dai FG-MBI), quando in realtà questo non è il caso?
  3. È necessaria che gli interventi psicologici vengono “de-spiritualizzate” prima di poter essere utilizzati in contesti clinici, o – basati su un approccio “ciò che funzione” – possono gli interventi che sono apertamente spirituali nella loro natura essere considerati come trattamenti sanitari pubblici attuabile, accettabile e affermati?

Nel tentativo di superare alcune delle questioni di cui sopra riguardanti FG-MBI, si sono compiuti degli sforzi negli ultimi anni per formulare e valutare empiricamente una seconda generazione di interventi basati sulla mindfulness. Interventi basati sulla mindfulness di seconda generazione (SG-MBI) ancora sono destinati ad essere utilizzati in contesti sanitari pubblici (vale a dire, essi sono ancora secolari in natura) ma – come spiegato nel seguente citazione tratta dal nostro articolo recentemente pubblicato nella rivista academica Mindfulness -sono apertamente spirituale in natura e sono più tradizionali nel modo in cui costruiscono e insegnano la mindfulness:

Grazie al suggerimento che alcuni individui possono preferire di essere formati/addestrati in una versione della mindfulness che assomiglia più ad un approccio tradizionale buddista, negli ultimi anni si è assistito alla valutazione di sviluppo e le fasi iniziali di diversi interventi basati sulla mindfulness di seconda generazione (SG-MBI) … Sebbene SG-MBI seguono ancora un formato secolare che è adatto per essere insegnato in tutta una gamma di impostazioni psicologiche, sono apertamente spirituale in aspetto e insegnano la mindfulness dall’interno di un’infrastruttura di pratica che integra quello che è tradizionalmente considerata come prerequisiti per un effettivo sviluppo spirituale e meditativo. Al livello più basilare (ma non il meno profondo), tali prerequisiti includono ogni elemento del Nobile Ottuplice Sentiero. Il Nobile Ottuplice Sentiero comprende ciascuno dei tre quintessenziale principi delle pratiche e degli insegnamenti buddisti di (i) la saggezza (cioè la retta visione, la retta intenzione), (ii) il comportamento etico (cioè la retta parola, la retta azione, il retto sostentamento), e (iii) la meditazione (cioè, il retto sforzo, la retta mindfulness, la retta concentrazione). Ciascuno di questi tre elementi fondamentali (sanscrito: trishiksha – i tre addestramenti) devono essere presente in qualsiasi percorso di pratica che pretende di esporre o di essere radicati nella autentica Buddhadharma e sono applicabili a (e costituiscono la base del) veicolo fondamentale o Theravada tanto quanto sono applicabili ai (e costituiscono la base dei) veicoli Mahayana e Vajrayana buddista. Così, per la pratica più efficace della mindfulness, essa deve essere insegnato come parte di un percorso spirituale comprensivo e deve essere insegnato da una guida spirituale che può trasmettere gli insegnamenti in modo autentico.

Lo sviluppo e la valutazione empirica di una seconda generazione di interventi basati sulla mindfulness sembra rappresentare una tendenza emergente nella ricerca della mindfulness. I risultati dal nostro lavoro di ricerca con Meditation Awareness Training (MAT), un SG-MBI corso di otto settimane, indicano che SG-MBI possono avere applicazioni nel trattamento di (i) workaholism, (ii) stress legato al lavoro, (iii) stress, (iv) l’ansia, (v) la depressione, (vi) la schizofrenia, e (vii) il gioco d’azzardo patologico. Recenti studi MAT che abbiamo condotto hanno anche dimostrato che SG-MBI possono contribuire a migliorare l’efficacia al lavoro, competenza decisionale e capacità di leadership/gestione più in generale. Studi di SG-MBI da parte di altri ricercatori anche indicano una vasta gamma di applicazioni cliniche e non-clinici per SG-MBI. Ad esempio, studi guidati dal Professor Nirbhay Singh indicano che SG-MBI possono avere utilità come (i) un programma di cessazione di fumare per persone con disabilità intellettiva lieve, (ii) un metodo di regolazione ddella rabbia per gli individui con schizofrenia e (iii) un programma di formazione e sostegno per i genitori al fine di ridurre il comportamento aggressivo e dirompente di loro bambini/adolescenti. Tuttavia, è necessario ricordare che la ricerca di SG-MBI è ancora in una fase iniziale e quindi, anche se i risultati di cui sopra sono promettenti, ulteriori indagini empiriche sono ovviamente necessari. Inoltre, è nostra opinione che piuttosto che competere direttamente con FG-MBI, SG-MBI semplicemente forniscono un approccio alternativo alla pratica della mindfulness che – per alcuni individui – può essere più attraente.

Please note: This article provides a summary of, and is adapted from, a discussion that first appeared in a paper we published in the journal Mindfulness.

Ven Edo Shonin & Ven William Van Gordon

Ulteriori letture

Carrette, J., & King, R. (2005). Selling spirituality: The silent takeover of religion. New York: Routledge.

Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.

McWilliams, S. A. (2014). Foundations of Mindfulness and Contemplation: Traditional and Contemporary Perspectives. International Journal of Mental Health and Addiction, 12, 116-128.

Rosch, E. (2007). More than mindfulness: when you have a tiger by the tail, let it eat you. Psychological Inquiry, 18, 258-264.

*Shonin, E., & Van Gordon, W. (2014) Manager’s experiences of Meditation Awareness Training. Mindfulness, DOI: 10.1007/s12671-014-0334-y. [Source Article].

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2013a). Mindfulness-based interventions: Towards mindful clinical integration. Frontiers in Psychology, 4, 1-4. DOI: 10.3389/fpsyg.2013.00194.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014c). The treatment of workaholism with Meditation Awareness Training: A case study. Explore: The Journal of Science and Healing, 10, 193-195.

Shonin, E., Van Gordon, W., Dunn, T., Singh, N., & Griffiths, M. D. (2014d). Meditation Awareness Training for work-related wellbeing and job performance: A randomized controlled trial. International Journal of Mental Health and Addiction,  DOI 10.1007/s11469-014-9513-2.

Shonin, E., Van Gordon, W., & Griffiths, M. D. (2014e). Cognitive Behavioral Therapy (CBT) and Meditation Awareness Training (MAT) for the treatment of co-occurring schizophrenia with pathological gambling: A case study. International Journal of Mental Health and Addiction, 12, 181-196.

Shonin, E., Van Gordon W., & Griffiths M. D. (2013). Meditation Awareness Training (MAT) for improved psychological wellbeing: A qualitative examination of participant experiences. Journal of Religion and Health, 53, 849-863.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, J. Curtis, W. J., Wahler, R. G., & McAleavey, K. M. (2007). Mindful parenting decreases aggression and increases social behavior in children with developmental disabilities. Behavior Modification, 31, 749-771.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazia, B. T., Singh, A. D. A., Singh, A. N. A., & Singh, J. (2013). A mindfulness-based smoking cessation program for individuals with mild intellectual disability. Mindfulness, 4, 148-157.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Karazsia, B. T., & Singh, J. (2014a). Mindfulness-Based Positive Behavior Support (MBPBS) for mothers of adolescents with autism spectrum disorders: Effects on adolescents’ behavior and parental stress. Mindfulness, DOI: 10.1007/s12671-014-0321-3.

Singh, N. N., Lancioni, G. E., Myers, R. E., Karazsia, B. T., Winton, A. S. W., & Singh, J. (2014b). A randomized controlled trial of a mindfulness-based smoking cessation program for individuals with mild intellectual disability. International Journal of Mental Health and Addiction, 12, 153-168.

Singh, N. N., Lancioni, G. E., Karazsia, B. T., Winton, A. S. W., Singh, J., & Wahler, R. G. (2014c). Shenpa and compassionate abiding: Mindfulness-based practices for anger and aggression by individuals with schizophrenia. International Journal of Mental Health and Addiction, 12, 138-152.

Van Gordon, W., Shonin, E., Sumich, A., Sundin, E., & Griffiths, M. D. (2014b). Meditation Awareness Training (MAT) for psychological wellbeing in a sub-clinical sample of university students: A controlled pilot study. Mindfulness, 5, 381-391.

Van Gordon, W., Shonin, E., Zangeneh, M., & Griffiths, M. D. (2014). Work-related mental health and job performance: Can mindfulness help? International Journal of Mental Health and Addiction, 12, 129-137.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2015). Mindfulness and the Four Noble Truths. In: Shonin, E., Van Gordon W., & Singh, N. N. (Eds). Buddhist Foundations of Mindfulness. New York: Springer.