Dismantling Mindfulness-Based Cognitive Therapy: Creation and validation of 8-week focused attention and open monitoring interventions within a 3-armed randomized controlled trial

Abstract

Background While mindfulness-based interventions (MBIs) employ two distinct practices, focused attention (FA) and open monitoring (OM), the integrated delivery of these practices in MBIs precludes understanding of their practice-specific effects or mechanisms of action. The purpose of this study is to isolate hypothesized active ingredients and practice-specific mechanistic target engagement by creating structurally equivalent interventions that differ only by the active ingredient (meditation practice) offered and to test whether the hypothesized components differentially engage the mechanistic targets that they are purported to engage. Methods Participants were intended to be representative of American meditators and had mild to severe affective disturbances. Measures of structural equivalence included participant-level (sample characteristics), treatment-level (program structure and duration, program materials, class size, attendance, homework compliance, etc.), and instructor-level variables (training, ratings and adherence/fidelity). Measures of differential validity included analysis of program materials and verification of differential mechanistic target engagement (cognitive and affective skills and beliefs about meditation acquired by participants after the 8-week training). Results The results indicate successful creation of structurally equivalent FA and OM programs that were matched on participant-level, treatment-level, and instructor-level variables. The interventions also differed as expected with respect to program materials as well as mechanistic targets engaged (skills and beliefs acquired). Conclusions These validated 8-week FA and OM training programs can be applied in future research to assess practice-specific effects of meditation.

Mindfulness, acceptance, and emotion regulation: perspectives from Monitor and Acceptance Theory (MAT)

“…To test whether learning acceptance skills is a critical emotion regulation mechanism of mindfulness interventions for improving affective, stress, and social relationship outcomes, recent studies have employed intervention dismantling designs. Dismantling designs have been recommended and used to identify active treatment elements of multi-component mindfulness interventions (33,34). We have adopted this experimental approach to test whether removing acceptance skills training from mindfulness interventions reduces or eliminates treatment-related improvements in emotion regulation-relevant outcomes.…”

Mindfulness and progressive muscle relaxation as standardized session‐introduction in individual therapy: A randomized controlled trial

“…A pilot study comparing MBCT in group and individual therapy showed significant symptom improvement in individual MBCT that was equally strong as in group MBCT (Schroevers, Tovote, Snippe, & Fleer, ). However, this study investigated the effects of the whole MBCT package and did not directly target the mindfulness exercise component (Britton et al, ). Furthermore, a meta‐analysis showed that mindfulness exercises as a stand‐alone intervention have beneficial effects on anxiety and depression in healthy subjects (Blanck et al, ).…”

Binary Model of the Dynamics of Active versus Passive Mindfulness in Managing Depression

“…Finally, in a novel study published this year, Britton and colleagues observed that mindfulnessbased interventions (viz., MBSR and MBCT) employ two distinct practices, namely, focused attention (FA) and open monitoring (OM) [78]. These two meditation practices were identified previously by Lutz and associates [79] as being central to mindfulness-based programs.…”