Holding the Heart of Mindfulness-Based Stress Reduction: Balancing Fidelity and Imagination When Adapting MBSR

Abstract

Mindfulness-Based Stress Reduction (MBSR) courses are being taught around the world in various contexts and targeted to various populations. The program has been intentionally designed without a detailed teaching manual so as to allow instructors to respond to what is called for in each teaching moment. It also affords tailoring the program to specific circumstances such as when working with persons suffering from depression or substance abuse. But how does one remain true to core teaching intentions and program components, while undertaking such tailoring? Modifications to the format and content of MBSR have been reported but little is known if these adaptations influence outcomes and processes underlying change compared to the basic curriculum. Here we discuss what we consider to be essential aspects of the program to be carefully considered when adapting it. We describe selected adaptations of MBSR to highlight the types of changes made and report results when data are available. We conclude with suggestions pertaining to how to best remain authentic while being imaginative regarding the administration of MBSR in non-medical settings (e.g., prison) and for special populations (e.g., women with addictions).

A qualitative study exploring the experiences of mindfulness training in people with acquired brain injury

“…A full-day (7 hours) silent retreat forms a part of the standard MBSR program . This day typically involves a series of guided meditations, offering an opportunity for seamless mindfulness practice and helps participants to consolidate their learning (Dobkin, Hickman, & Monshat, 2014). However, only three out of nine studies using MBSR program included a retreat session.…”

Telephone-adapted mindfulness-based stress reduction (tMBSR) for patients awaiting kidney transplantation: Trial design, rationale and feasibility

“…The adaptations made to the standard MBSR curriculum are congruent with the recommendations of McCown et al [28] and Dobkin et al [57]. The format of MBSR was rearranged to allow for six of the eight weeks to be delivered by teleconference and the retreat was conducted in week 8 as a 5-hour workshop, yet the content from the formal template curriculum and the teaching intentions and axioms (intention, attention and attitude) were retained.…”

Assessing Fidelity of Implementation (FOI) for School-Based Mindfulness and Yoga Interventions: A Systematic Review

“…Although not formally articulated as essential program features, one study reviewed here adapted Crane and colleagues’ work as part of their adherence checklists completed at each session (Metz et al 2013). Second, Patricia Dobkin and her colleagues have recently outlined a framework for balancing “fidelity” to the four chambers of MBSR, which include: form, content, instructor, and intention with the “imagination” of making appropriate adaptations to populations, occupation, and institutional regulations (Dobkin et al, 2013). This approach offers another way to conceptualize the essential features or core program components of mindfulness-based programs, allowing room for both fidelity and adaptation.…”