Addressing Diversity in Mindfulness Research on Health: A Narrative Review using the ADDRESSING Framework

Abstract

INTRODUCTIONOver the past 5 years, the number of Americans practicing meditation has more than tripled, rising from 4% of adults in 2010 to 14% in 2017. 1 This rise is likely related to the increasing focus on preventive and integrative approaches to healthcare in the United States, such as meditation, whih is often used to reduce stress, anxiety, depression, and pain in conjunction with improving health and well-being. 2 While many different meditative practices exist, mindfulness meditation emphasizes nonjudgmental awareness of the present moment. Although substantial research supports mindfulness-related improvements in patient-reported mental and physical health, 3 the replication crisis in social science and medicine, alongside numerous methodological concerns about extant mindfulness studies, 4 invites questions regarding the generalizability of research on the reported health-promoting effects of mindfulness meditation and mindfulness as an innate, dispositional quality (trait mindfulness). Moreover, as much of mindfulness research over-samples middle-to-upper class, Caucasian, women, 5 the extent to which results generalize to a broader, more diverse population is unclear. One possible reason for this overrepresentation could be that this population has the time and/or finances to participate in mindfulness-based interventions (MBIs) from which researchers draw samples. In 2001, Dr. Pamela Hays published Addressing Cultural Complexities in Practice, 6 introducing the ADDRESSING framework as a guide to help clinicians better identify and understand the relevant cultural identities of their clients. According to Dr. Hays, the facets of identity include: Age, Developmental and 10 Chin et al.: Addressing Diversity in Mindfulness Research on Health Published by Rowan Digital Works, 2019acquired Disabilities, Religion, Ethnicity, Socioeconomic status, Sexual orientation, Indigenous heritage, National origin, and Gender. This framework allows room for intersectionality between identity facets and does not inherently exclude non-minority individuals. As such, the ADDRESSING framework, with its attention to multiple aspects of identity, provides an effective structure for organizing research published on different populations and identifying 1) which populations are represented and underrepresented in various categories and 2) what is known about underrepresented groups in research. The main purpose of this review, therefore, was to use the ADDRESSING framework to highlight mindfulness research conducted on historically underrepresented groups as both a method to summarize what has been done and to point out gaps for future research. METHODS Wesearched MEDLINE, PsychINFO, and Web of Science through September 2018 using the following combination of keywords: (diverse OR age OR disability OR race OR ethnicity OR Black OR White OR Latino OR Hispanic OR Asian OR gender OR transgender OR sexual orientation OR lesbian OR gay ORLGBT or LGB OR homosexual OR bisexual OR asexual OR socio-economic status OR SES OR low-income...

Do gender, anxiety, or sleep quality predict mindfulness-based stress reduction outcomes?

“…In addition, individuals who reported higher baseline anxiety and greater sleep quality complaints experienced greater decreases in stress-related physical symptoms, and individuals reporting higher baseline anxiety had greater improvements in cognitive reappraisal; these benefits did not differ by gender. Previous literature that looked at gender differences during MBSR treatment found similar results, where the populations were predominantly women, but both men and women reported significant improvements in health outcomes post-treatment (Chin et al, 2019). Together with existing data, the present study demonstrates the effectiveness of MBSR and other MBI’s for populations with elevated symptoms of anxiety and sleep disturbance.…”

“…Limitations included reliance on self-report measures, lack of a control group, possible expectancy effects associated with paying to take the MBSR program, and a primarily female, Caucasian, high socioeconomic status sample. Nevertheless, the current findings are among the first to directly compare MBSR outcomes for women and men in the same program, while also examining the interaction between gender and baseline distress levels in predicting MBSR outcomes, thereby advancing a nascent field trying to better address diversity issues in mindfulness research (Chin et al, 2019).…”

“…Far less is known about who is most likely to benefit from mindfulness training and how to optimize MBSR outcomes. For example, the degree to which outcomes of mindfulness-based interventions (MBIs) generalize across diverse groups, including their effects among women versus men, remains unclear (Chin et al, 2019).…”

Mindfulness interventions for offsetting health risk following early life stress: Promising directions

“…A review of 69 MBI RCTs conducted in the United States reported an oversampling of white, higher SES women: ¾ of participants were white, 70% were women, and participants’ educational attainment and income were higher than US averages ( Waldron et al., 2018 ). Thus, whether MBIs are acceptable and salubrious in populations underrepresented in research is a critical question ( Chin et al., 2019b ). Importantly, lower SES and racial minority status are associated with elevated inflammation and poorer health in part through stress exposure that often begins in childhood ( Williams et al., 1997 ).…”

Mindfulness and Health: The Nursing Science Bridge

“…Importantly, there is a lack of knowledge as to the feasibility, acceptability, and efficacy of mindfulness-based approaches designed to target the unique stressors, health needs, and values of diverse populations. It is essential that the next wave of mindfulness research address “the potential health benefits of mindfulness across diverse, underrepresented, and medically underserved communities” (Chin et al, 2019, p. 9), and how to reduce barriers that limit accessibility of mindfulness to these vulnerable groups .…”