Received 08/25/11 Revised 10/28/11 Accepted 02/21/12

Mindfulness-Based Interventions in Counseling
Amanda P. Brown, Andre Marquis, and Douglas A. Guiffrida
Mindfulness is a relatively new construct in counseling that is rapidly gaining interest as it is applied to people struggling with a myriad of problems. Research has consistently demonstrated that counseling interventions using mindfulness improve well-being and reduce psychopathology. This article provides a detailed definition of mindfulness, including a discussion of the mechanisms underlying mindfulness practice; explores the implementation of mindfulness as a counseling intervention; and examines literature supporting its effectiveness. Keywords: mindfulness, counseling, meditation, mindfulness-based cognitive therapy

During the last 30 years, mindfulness has attracted a great deal of attention from counseling researchers and practitioners and is the subject of a quickly growing body of research. Currently, more than 1,500 articles can be found with “mindfulness” in the title when searching the PsycINFO computer database. Additionally, a recent poll conducted by the Psychotherapy Networker found that over 41% of the 2,600 therapists who completed their survey reported integrating some form of mindfulness into their therapy practice (Siegel, 2011). Jon Kabat-Zinn (1994), one of the f irst and most well-known scholars to integrate mindfulness into Western healing practices, defines mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (p. 4). The current body of mindfulness literature suggests that integrating this seemingly simple approach into counseling yields consistently positive outcomes with clients. One of the most striking themes in the literature is the apparent helpfulness of mindfulness in alleviating the symptoms of many distressing problems, including generalized anxiety disorder (Hofmann, Sawyer, Witt, & Oh, 2010), depression relapse (Piet & Hougaard, 2011; Teasdale & Ma, 2004), borderline personality disorder (Linehan, 1993), eating disorders (Wolever & Best, 2009), and drug addiction (Bowen, Chawla, & Marlatt, 2011), as well as improving general well-being (Hölzel et al., 2011). In addition, research suggests that counselors’ own personal practice of mindfulness benefits their clients, even when their clients are not themselves practicing mindfulness and are unaware that their counselor is (Grepmair et al., 2007). Yet, despite the strong empirical support for the use of mindfulness in counseling, few articles have been published on this topic in counseling journals. In this article, we define mindfulness, explore the implementation of mindfulness in counseling practice, and examine a selection of literature supporting its effectiveness.

Defining Mindfulness
Human beings have been imparting and practicing mindfulness skills as a means of easing psychological suffering for at least 2,500 years (Teasdale, 1999b). While the practice is strongly tied to the teachings of the Buddha, others have pointed out that mindfulness practices date back thousands of years before the Buddha’s time, with roots in ancient yogic practices (Miller, Fletcher, & Kabat-Zinn, 1995). Although mindfulness originated from Eastern spiritual teachings, the practice of relating to one’s experience in the present moment with acceptance and full awareness is by no means limited to a particular religious tradition. By its very nature, mindfulness is a mode of awareness that is universally accessible in that anyone can learn it and practice it (Bishop et al., 2004). Bishop et al. (2004) proposed that there are two essential components that constitute mindfulness as discussed in the literature: an open attention to one’s present experience, accompanied by a nonjudgmental, accepting attitude toward whatever one encounters. These complementary elements can be easily identified in this concise definition: “nonjudgmental moment-to-moment awareness” (Miller et al., 1995, p. 193). A person’s experience refers not only to what is occurring around her or him (e.g., sights, sounds, events) but also what is most often unattended to: internal experience (e.g., physical sensations, emotions, thoughts). As Epstein (1995) succinctly put it, “[Mindfulness] is quite literally coming to one’s senses” (p. 144). It is important to distinguish between mindfulness and concentrative practices. As Epstein (1995) explained, concentration consists of “rest[ing] the mind in a single object of awareness” (p. 132), with the aim of achieving singlepointedness; thus, when attention strays, it is redirected to that object. In contrast, mindfulness involves a moment-tomoment bare attention to whatever arises within one’s field of awareness. At times, the mindfulness literature fails to differentiate between these two distinct meditative approaches,

Amanda P. Brown, Department of Psychology, Emory University; Andre Marquis and Douglas A. Guiffrida, Department of Counseling and Human Development, University of Rochester. Correspondence concerning this article should be addressed to Amanda P. Brown, Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322 (e-mail: apbrow6@emory.edu). © 2013 by the American Counseling Association. All rights reserved.

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Journal of Counseling & Development  ■  January 2013  ■  Volume 91

they are encouraged by the counselor to direct their awareness to their breathing. as a result. Additionally. Clients should also be informed about research that has supported the effectiveness of mindfulness in counseling and healing more generally. Lipworth. Burney. (b) is targeted toward diverse client populations. Williams et al. 2011). Additionally.. therefore. mindfulness might be misunderstood as somehow fostering the suppression of thoughts and feelings. Likewise. Counselors using mindfulness in their practice begin with psychoeducation. the counselor can begin instructing clients in basic mindfulness-based meditation techniques. Thus. DBT proved highly effective and. gained widespread attention from the counseling and psychotherapy community.g. 2003). accessible through a variety of mindfulness techniques. the thrust of mindfulness is neither to seek pleasant experiences nor to avoid unpleasant experiences. that mindfulness can be used by counselors from various theoretical orientations—including. It is reasonable. regulating one’s attention in a mindful way creates an inner attitude that neither suppresses nor indulges transient cognitions and emotions (Chodron. as a potential mechanism of change. Segal. clients can be encouraged to view their thoughts as clouds floating by in the sky of their minds. 2007) before beginning their formal mindfulness experience in therapy so that they are able to gain a more complete understanding of this unique approach to counseling and healing. but not limited to.. Strosahl. & Sellers. Journal of Counseling & Development  ■  January 2013  ■  Volume 91 . Readers are referred to Kabat-Zinn (1990). 1990. Once again we are presented with what may seem counterintuitive about mindfulness practice—what Baer (2003) called a “paradoxical attitude of nonstriving” (p. which integrates the core mindfulness concepts of awareness and acceptance with cognitive behavioral principles. and more adaptive mode of consciousness. and (c) integrates mindfulness principles with vastly different established counseling theories. 1986). It is important that there is clarification among counselors about which approach is actually being implemented.. 1994). therefore. reduces reactivity to distressing emotions and thoughts. however. counselors can refer clients to mainstream literature that provides a basic overview of mindfulness practice (e. This description is intended to provide only a broad overview of these processes. After clients learn about the fundamental elements of mindfulness. Rather. planning for the future. MBSR is a long-standing program that has consistently demonstrated its effectiveness in alleviating stress and chronic physical pain (Kabat-Zinn. Williams. all three approaches share much in common with regard to the ways in which the core principles of mindfulness are woven into the counseling process. 1990). Shaw. To assist in this process of nonreactivity. and Wilson (1999) developed what is currently referred to as acceptance and commitment therapy (ACT). the potential implications of mindfulness extend well beyond stress reduction. Relaxation has been identified as a measurable result of mindfulness practice and. Segal et al. thus providing a more reflective. (2002). with the introduction of Linehan’s (1993) dialectical behavior therapy (DBT. This is begun by teaching clients to sit quietly while observing whatever enters their field of awareness—whether thoughts. especially for stress-related disorders (Baer. It is believed that this nonstriving attitude. in which clients learn about the foundational elements of mindfulness. Kabat-Zinn. Kabat-Zinn. Around the same time. Hayes. When clients begin to notice themselves becoming overly involved with a particular thought. but rather to be nonjudgmentally aware of whatever arises in one’s present field of awareness. Developed as a means for working with clients with borderline personality disorder (a group previously regarded as difficult and even resistant to psychotherapy). 2004). mindfulness is not considered a relaxation technique (Bishop et al. Teasdale. 130) and Kabat-Zinn (1990) called “non-doing” (p. clients are instructed to use their own breath as an anchor to keep themselves from being distracted by or reacting to their thoughts. Rush. and Williams. those that formally integrate it—to assist with a variety of client issues (Martin. This approach combined Beck. Despite the fact that each of these approaches (a) was developed independently. which are allowed to gently pass without any reaction (Kabat-Zinn. In fact. and labeling and making judgments about everyday experiences. It is important that counselors normalize these human tendencies so that clients realize that they are not the only ones failing to live life fully present and nonjudgmentally. 60). Instead. Next we provide a basic overview of how mindfulness can be incorporated in counseling practice. focusing specifically on their particular area of distress if such literature is available. Orsillo & Roemer. 1997). Siegel. emotions. 1997. and Emery’s (1979) cognitive therapy with fundamental techniques used in Kabat-Zinn’s (1990) mindfulness-based stress reduction (MBSR). 2011. less disturbed. including the tendencies of the human mind to become preoccupied with thinking about the past. Shortly thereafter. while stress is often reduced through mindfulness practice. or sensations—without emotionally reacting to or judging them.Mindfulness-Based Interventions in Counseling and some interventions that use concentrative techniques are mislabeled as mindfulness. and Kabat-Zinn (2007) for more detailed descriptions regarding the described activities. Orsillo and Roemer (2011). Segal. it is a form of mental discipline that helps reduce a person’s tendency to react to cognitions in ways that lead to stress responses. This involves intentionally observing the sensations of their natural breathing process—from air moving against their nostrils and the back of their throat to the changing sensations of 97 Mindfulness in Counseling Mindfulness began to gain popularity in counseling and psychotherapy in the early 1990s. and Teasdale (2002) introduced mindfulness-based cognitive therapy (MBCT) to prevent depressive relapse in clients with recurrent depression.

When she notices that her attention has drifted away from the anchor(s) connecting her to the present moment. 292). like her back against the seat. because intentionally working with awareness in this way is in direct conflict with habitual modes of human functioning and with many cultural norms. which. counselors can help clients identify activities that lend themselves most easily to mindfulness practice. In this way. Being able to step back from one’s internal processes with an inner posture of nonattachment. often a raisin (Kabat-Zinn. and so on. body scan. Only after one attempts to practice mindfulness does it become clear. sitting meditation). the quality of attention that is cultivated through the sitting meditation needs to be integrated into the client’s daily life. and physical sensations in the midst of everyday activities. or mindful eating. While different authors may use distinct frameworks and terminology to describe core processes that undergird successful therapeutic interventions (e. systematic practice.. emotions. Beck et al. Thus. Successful mindfulness interventions. By providing clients with a means for exploring unpleasant thoughts. walking. First. 1997. the underlying process that seems to allow for their effectiveness is similar. when she realizes that she has lost the awareness of her feet on the floor and has been planning tomorrow’s dinner. for some clients. the feeling of her feet on the floor. that our conditioned mode of operating is dominated by automatic internal processes that ultimately obstruct living fully in the present moment. 1997. Many mindfulness programs also incorporate homework journals or daily worksheets as a tool to support clients in developing a regular practice. such as a sitting meditation.g. The client is then instructed to focus her awareness on the sight and texture of the raisin in her hand. 1990). As a woman sits and drives. Martin (1997) has proposed that mindfulness is a “core process” that underlies seemingly diverse therapeutic approaches (p. This inevitable struggle with deeply ingrained patterns is partly why diligent practice to sustain nonjudgmental. 1997). with respect to their mechanisms of action. through direct experience. can also be used to enhance the effectiveness of most traditional talk therapies. In this way. or the rhythm of her breathing. 2000). the counselor encourages the client to sit comfortably and ground her attention in the physical sensations of her body. or behaviors. Kabat-Zinn. the counselor teaches clients to use their breath to anchor them to the present moment. 1997. and acceptance can lead to a “state of psychological freedom” (Martin. during which the client is guided through 45 minutes of nonjudgmental. sequential attending to physical sensations until arriving at a unified awareness of the whole body (see Kabat-Zinn. we might consider the application of mindfulness to a mundane activity like driving a car. she grounds her attention in one or more physical sensations. counselors can help facilitate client awareness by teaching them the process of mindful eating.. To facilitate regular practice of the body scan in daily life. 1990). however. is often challenging for clients 98 at first. accepting attitude toward one’s experience seems to create a state of emotional nonreactivity that is powerful and healing in and of itself (Chodron. the taste. in addition to regularly integrating mindfulness into their daily activities. In addition to formal mindfulness practices. To assist clients in integrating mindfulness into their daily activities.’s [1979] “decentering” or Bohart and Tallman’s [1996] “detachment”). p. clients are encouraged to devote some time—even if only 5 to 10 minutes—every day to a formal mindfulness practice. Additionally. can include other mundane tasks. As the client swallows. Another more active form of mindfulness meditation that counselors can use with clients is the body scan. or other preoccupations. feelings. Marquis. without judging herself. especially those with less severe or nonpathological problems. require clients to maintain a level of discipline and regular. and so on. worries. For instance. In other words. This activity is typically conducted using a single piece of fruit. To illustrate this idea. Practicing mindfulness. 291). returns her attention to her perceptions of the driving conditions and the sensations of her body. later the smell. and so forth. Several authors have noted that the simple practice of observing oneself with a nonjudgmental. Thus. the surrounding cars. Martin. Mindfulness-based intervention (MBIs). The counselor reminds the client that if she realizes her attention has drifted away from her current experience of the raisin and has been engaged with thoughts. in addition to driving a car. the internal state of attentional freedom that is facilitated by mindfulness training can be considered a core process that is necessary in order for clients to engage in meaningful change.Brown. she gently brings her attention back to her present sensations and perceptions. 1994). open attention is a critical component of mindfulness training. nonidentification. she focuses her attention on the external stimuli of the road in front of her. she acknowledges this observation and. mindfulness can help counselors from virtually any theoretical orientation facilitate change processes in their clients (Martin. & Guiffrida their belly touching their shirt as the abdomen rises and falls (Kabat-Zinn.g. ironing clothes. clients are typically provided with audio recordings containing this and other guided exercises (e. Journal of Counseling & Development  ■  January 2013  ■  Volume 91 . many of which may have previously been unnoticed or perceived as too overwhelming for them. gardening. whether in formal meditation or in regular daily activities. This formal practice strengthens their capacity to cultivate mindfulness throughout the day. Simultaneously. 1994. counselors using mindfulness approaches also help clients be more present to their thoughts. In fact. she is encouraged to attend to the sensations of the raisin as it makes its way down her throat and into her stomach. such as doing dishes. gently returns her attention to her physical experience of the raisin. the basic mindfulness interventions described above may be all that is needed for them to successfully negotiate the difficulties that brought them into counseling. therefore. A recurrent theme in counseling and psychotherapy literature is the observation that mindfulness training overlaps with many established empirically supported treatments. without judging herself. Welwood. she acknowledges this fact and.

” or SR-RP (KabatZinn.Mindfulness-Based Interventions in Counseling The idea of a core therapeutic process can also be understood through an examination of the relationship between MBIs and cognitive therapy. emotion regula- Journal of Counseling & Development  ■  January 2013  ■  Volume 91 . and this body of literature is rapidly growing. which is generally lacking in the mindfulness research literature.to 10-week intervention significantly improves participants’ psychological functioning and reduces distress across a variety of domains. Furthermore.95 for anxiety and depression. 2006). This distinction is of particular importance and highlights the paradoxical nature of mindfulness training: By simply observing one’s thoughts without intending to change them. 2011). and reduced compassion fatigue and burnout (Christopher & Maris. the key difference between these two frameworks lies in their designated targets of change and corresponding therapeutic techniques. but rather to change the client’s relationship to these psychological phenomena.97 and 0.g.. 8. These findings indicate a robust treatment effect. In applying mindfulness with clients. as maladaptive. there has been a proliferation of research investigating mindfulness training. Alternatively. dysfunctional. they can choose to relinquish their attachment to them and begin to consider alternative ways of being. increased mindfulness) may be the core process responsible for changing thought patterns in cognitive therapy. and with nonclinical populations along dimensions such as empathy and self-esteem (Hölzel et al. (2010) recently conducted a meta-analytic review of the efficacy of mindfulness-based therapies for relieving mood and anxiety symptoms in populations with a variety of psychiatric and medical conditions. respectively). 2010. it is essential for counselors to understand this principle to accurately identify the correct target of change: the relationship toward thoughts. thoughts. 2011). Overall. not the thoughts themselves. Compared with other treatment interventions of its kind. 2011). the resulting change in the client’s relationship to her thoughts (i.. 2010). Cognitive therapy explicitly focuses on changing the content of negative or maladaptive beliefs and thoughts through strategies such as cognitive restructuring to change clients’ beliefs in automatic negative thoughts and dysfunctional assumptions (Teasdale. One study in particular evaluated an intervention program modeled closely after MBSR that aimed to reduce and prevent stress symptoms in a nonclinical population of 28 undergraduates (Astin. respectively). MBSR has been subjected to the most empirical testing and has garnered the most evidence supporting its effectiveness. before conducting the meta-analysis. Interestingly. Hofmann et al.59. suggesting that mindfulness-based therapies are efficacious for improving depression and anxiety symptoms in heterogeneous clinical populations. however. Incorporating data from both controlled and uncontrolled studies. Kristeller & Wolever.. one can create the experience of recognizing any cognitive phenomena as both separate from oneself and not necessarily reflective of any particular reality or truth. it implicitly leads to a change in relationship to these beliefs and thoughts (Teasdale. they had adopted a critical view toward the efficacy of MBIs. For clients with diagnosable anxiety disorders and depression. Many researchers across various specializations have designed and tested interventions that either incorporate or are based on mindfulness techniques. results indicated that these effects were maintained over an average 27-week follow-up period. the authors of this review acknowledged that. This study is noteworthy because it used a randomized control design. mindfulness training specifically discourages the judging or labeling of thoughts (e. Thus. acceptance and commitment therapy). such as panic attacks (Miller et al. MBIs make explicit that the goal of sessions is not to change beliefs. we provide a brief review of salient outcome research on two of the most widely studied mindfulness-based clinical interventions: MBSR and MBCT.140 clients.. 1982).63 and 0. and we discuss research on two other approaches that integrate mindfulness as a part of the therapeutic intervention (dialectical behavior therapy. results support the use of mindfulness for many clinical conditions. designed in the 1980s by Kabat-Zinn. & Carlson. Ultimately. As described earlier. 1999a). While both attend primarily to cognitions. There have also been a number of studies that focus on examining the effectiveness of the aforementioned counseling approaches that specifically integrate mindfulness into the therapeutic process. Hedges’s g is a variation of Cohen’s d that corrects for biases resulting from small sample size (Hedges & Olkin.. Effect size estimates were derived from a sample of 39 studies. Participants were randomly 99 Research and Empirical Support Within the past 30 years. large effect sizes were reported (Hedges’s g = 0. one of the first and most cited mindfulness intervention programs in the literature is MBSR. pre–post effect sizes were in the moderate range for improvement of anxiety and depression symptoms (Hedges’s g = 0. 1995). who originally coined it “stress reduction and relaxation program. Speca. from increasing self-compassion to reducing binge-eating behavior (Birnie. mindfulness provides the opportunity for clients to recognize that their thoughts and emotions are transient and often insubstantial. This radical shift in relationship to one’s thoughts and emotions can provide the foundation needed for successful psychotherapy from any theoretical approach. because of this. In the following paragraphs. tion (Arch & Craske. such models provide a working foundation to guide counselors in understanding the application of this promising modality. which included a total of 1. 2011. 1999a). Hölzel et al.. Although we do not fully understand the mechanisms by which mindfulness skills operate (see Hölzel et al. 1997). It may be that although cognitive therapy explicitly focuses on changing negative beliefs and thoughts. In fact. A number of independent studies demonstrate that this outpatient. 1985).e. or feelings. irrational).

in itself. 2010). Two out of the six total studies compared MBCT to maintenance antidepressant medication (m-ADM).. In a recent meta-analysis.g. After the 8-week period. however. (2002) compared the effect of MBCT to TAU in a study in which participants with a history of recurrent major depression were randomly assigned to either group. Unlike MBSR. was one methodological weakness of the Astin (1997) study. however. seems to lead to reductions in relapse rates. for individuals with only two prior episodes of depression.Brown. increased use of an “accepting” control mode in their lives. RCT study published in a peer-reviewed journal).. compared with TAU. a well-controlled evaluation such as this instills greater confidence in the outcomes. MBCT significantly reduced relapse in major depression for participants with three or more previous episodes. Marquis. like most published mindfulness research. However. Originally developed to prevent relapse in people with recurrent major depressive disorder (MDD).g. Teasdale et al. those whose relapses are triggered by significant life events in contrast to ruminative thinking). those with low versus high risk of relapse. increased overall domain-specific sense of control. Segal et al. While Teasdale et al. In a similar RCT study reported in the same article.. in contrast to the entire range of one’s internal and external experience. who received either treatment as usual (TAU) or placebo. mean age = 46).” “metacognitive insight. metacognitive awareness. almost entirely female sample. In the TAU condition. was significantly greater in the MBCT group compared with that in the TAU group. it also significantly increased metacognitive awareness as measured by the MACAM. The authors suggest that while MBCT is clearly an effective prophylactic program for recurrent depression when an individual has had three or more prior episodes. 2002. Participants are instructed to complete various daily homework exercises on their own that are intended to cultivate a mindful cognitive processing mode. Six randomized controlled trial (RCT) studies were systematically screened and selected based on a specific set of inclusion criteria (e. for an overall mean risk ratio of 0. this program combines elements of cognitive therapy with MBSR training.g. participants sought help from their family doctor or other sources as they normally would. Not only did cognitive therapy significantly reduce relapse compared to antidepressant medication. This approach is essentially a delimited use of mindfulness in that it focuses most heavily on negative thoughts and feelings. Also.” or “a cognitive set in which negative thoughts and feelings are seen as passing events in the mind rather than as inherent aspects of self or as necessarily valid reflections of reality” (Teasdale et al. MBCT is another frequently and comprehensively evaluated MBI in the literature.. and its techniques are taught in groups of up to 12 participants that meet for eight weekly sessions. health skills training). & Guiffrida assigned to either an experimental group that received MBSR or a waitlist control group. the findings indicated a nonsignificant trend in favor of TAU over MBCT (49% risk reduction). MBCT was specifically designed as a prophylactic. increased mindfulness. Data from a total of 593 participants with recurrent MDD in remission contributed to the final analyses (74% women. The aim of MBCT is to foster what the authors call “metacognitive awareness. MBCT appeared to be particularly effective for individuals with three or more prior depressive episodes. Piet and Hougaard (2011) evaluated the effect of MBCT on recurrent MDD in remission. The authors noted that the MBCT program is intended to cultivate metacognitive awareness (a change in one’s attitudes toward or relationship with one’s thoughts) in participants without any explicit attempts to change the content of one’s beliefs or thoughts... Although this study did not compare the cost-effective MBCT group program 100 Journal of Counseling & Development  ■  January 2013  ■  Volume 91 . p. which did not allow the researchers to distinguish between the effects of group membership and mindfulness training more specifically. this study used a waitlist control design instead of an alternate control group design (e. has the power to significantly reduce relapse in MDD without attempting to change the content of beliefs in negative thought patterns or in the underlying assumptions of those thought patterns. MBCT is at least as effective as m-ADM for preventing depressive relapse. Instead. future research is required to better understand the distinct responses of certain subgroups (e. participants in the experimental condition experienced significantly greater reductions in overall psychological symptomatology. 2008. (2002) were able to perform only partial mediation analyses—because of the timing of assessments—their results suggested that both cognitive therapy and MBCT may operate through the same mechanism of increasing metacognitive awareness. 285). The authors found that MBCT participants relapsed significantly less (38%) than control participants (58%). as measured by the Measure of Awareness and Coping in Autobiographical Memory (MACAM). Following the intervention. or metacognitive awareness. and had higher ratings on a measure of spiritual experiences. Although similarly encouraging results have been published from many other studies of mindfulness-based approaches. Piet and Hougaard (2011) also concluded that because the risk of relapse associated with MBCT (45%) was not significantly different than the risk of relapse associated with m-ADM (56%). It appears that MBCT. on the basis of the results from these two studies (Kuyken et al. The small. psychotherapeutic intervention. Furthermore. however. The authors further noted that MBCT appears to be a cost-efficient strategy when compared to m-ADM and may even require as few as 3 therapist contact hours per client.66. these authors compared cognitive therapy to antidepressant medication and demonstrated that lower levels of metacognitive awareness predicted earlier relapse. These results simultaneously highlight the need for comprehensively sound methodology and provide preliminary support for mindfulness as an effective intervention.

. correlations ranged from . insight-oriented forms of mindfulness (e. Mindfulness assessments intended for children have also emerged. a growing body of well-controlled studies is establishing DBT as a particularly effective modality for clients with borderline personality disorder and a history of suicidal behavior (Linehan et al. 1997).88). Hopkins. “I think some of my emotions are bad or inappropriate and I should not feel them”) are rated on a 5-point Likert scale from 1 (never or very rarely true) to 5 (very often or always true). results supported the construct validity of the FFMQ. Buchheld. Two other cognitive behavior approaches that integrate mindfulness into their therapeutic strategies are DBT (Linehan. According to Miller et al. Other instruments have been designed to measure mindfulness also.05.. Research suggests that construct validity may be threatened both by a general lack of meta-awareness regarding one’s absence of mindfulness as well as a response bias to deny these mindless states (Van Dam. 197). 2009). together accounting for 39% of the variance in scores on the Ryff (1989) Scales of Psychological Well-Being. Kumar. Although the cultivation of mindfulness in individuals with extreme cognitive impairment. describing. Krietemeyer.35). or fragmented sense of self).. Although the FFMQ has not yet been validated with socioeconomically diverse samples or individuals who are new to meditation.. including regular meditators. it seems fair to assume that anyone with intact. basic cognitive functioning should be capable of cultivating his or her attention in this manner. which is intended to measure dispositional or trait mindfulness— specifically open or receptive present-moment awareness. Greeson. concentrative forms of meditation appear helpful to such people (Boorstein. (1995).g. The items (e. (2011) described successfully using mindfulness with adolescents with autism to self-manage physical aggression. the Kentucky Inventory of Mindfulness Skills (Baer. 2008). t(98) = 2. 2006). One of the most widely used of these measures is the Five Facet Mindfulness Questionnaire (FFMQ. Both the MAAS and the FFMQ are accessible and free to download online (www. 2006). Baer.html).g. spiritual.mindfulnessandacceptance. and a community sample of nonmeditators (Baer et al. profound developmental disability.Mindfulness-Based Interventions in Counseling with traditional individual cognitive therapy. Each of its 15 items (e. .. psychosis). in fact. & Allen. Masuda.017 individuals completed the questionnaire. 115). For example.72 to . Bond. All facets except observing demonstrated incremental validity in predicting psychological well-being. In a sample of 414 undergraduates. The MAAS has a unidimensional factor structure and takes roughly 5 minutes to complete.e. 2007). Earleywine. While there is insufficient research to conclude that ACT is more effective than other active psychotherapy treatments (Hayes.. 2004) and the Cognitive and Affective Mindfulness Scale (Feldman. demographically similar nonmeditators.vcu. a 39-item self-report measure designed to assess five factor analytically derived facets of the broader construct of mindfulness: observing. emotionally vulnerable. Singh et al. acting with awareness. which has demonstrated preliminary evidence for adequate reliability and convergent and discriminant validity (Greco. Kleinknecht.50.. the assessment instruments described earlier provide counselors with useful tools for assessing baseline levels of mindfulness and the efficacy of their mindfulness interventions over time. 101 Journal of Counseling & Development  ■  January 2013  ■  Volume 91 . 2006). 2006). a highly unstable. Buttenmüller. Vipassana) are contraindicated for individuals who are suicidal. or severe psychological disturbance (e. Notwithstanding these potential limitations. accepting without judgment. Although there is evidence that the open. these results inform a comparison of the two approaches. Cohen’s d = . Van Dam. and religious traditions” (p. is something that virtually all participants are capable of if sufficiently motivated” (p. and Borders (2010) reported good internal consistency for the MAAS (Cronbach’s alpha of . may be more difficult. or are suffering from underregulated ego functions (i. a 10-item questionnaire designed for youth over age 9. & Schmidt. 1.g. it is presently one of the leading instruments for assessing mindfulness. Brown and Ryan (2003) reported high test–retest reliability in a sample of undergraduates (intraclass correlation of . “[Mindfulness] . & Smith. Baer. such as the Child and Adolescent Mindfulness Measure. & Laurenceau. . counselors using these instruments with clients should keep in mind that self-report measures of mindfulness can be limited by individuals’ abilities to accurately report their states of mind. & Lillis. Results indicated adequate to good internal consistency (alpha coefficients ranged from . Smith. Brown & Ryan. 1993) and ACT (Hayes et al. 2011). Hayes. Mindfulness also appears to be relevant to culturally diverse clients. and nonreactivity. The FFMQ takes roughly 10 minutes to complete. & Danoff-Burg. p < . nonmeditating undergraduates.81) and significant differences in the MAAS scores of experienced Zen meditators when compared with those of matched nonmeditators. including the Freiburg Mindfulness Inventory (Walach.92). In a study assessing the psychometric properties of the FFMQ. meditation experience was significantly and positively correlated with four of the mindfulness facets (all except acting with awareness. have recently suffered a trauma.g. Likewise. Christopher and Maris (2010) argued that “the experience of mindfulness is universal and found in virtually all cultural. Luoma. 1999). 2003). Smith. Even when controlling for age and education level.45..edu/ tools. A second popular instrument is the Mindful Attention Awareness Scale (MAAS. that is far from the case for DBT. & Toney. As with most measures using self-report data. Earleywine.14 to . “I rush through activities without being really attentive to them”) represents mindless states and is rated on a 6-point Likert scale. Several measures of mindfulness have been created to operationalize and assess the construct and can serve as useful tools to monitor clients’ changes in mindfulness over the course of treatment.

Relatively speaking. it is not surprising that a number of researchers have called for better controlled studies. (2006). in the omission of descriptions regarding counselors’ training in mindfulness and the fidelity with which the interventions are implemented.. & Walach. 10. Similarly. Additionally.g. 97–106. Arendt. for example. B. which is evident. with longer follow-up periods and detailed data collected on practice behavior). Journal of Counseling & Development  ■  January 2013  ■  Volume 91 . the literature on younger children and older populations is far less developed (Greco et al. is that “once mindfulness has been developed. Whether being used to augment traditional counseling approaches or as a stand-alone prevention strategy. depressed clients. R. or is some level of ongoing. posed by Epstein (1995).. Baer.. K. Splevins.Brown. Astin. & Guiffrida Conclusions and Implications Is it possible that mindfulness is something of a panacea. rather.e. Fink. further research is required to examine the long-term effect of mindfulness as a function of the duration and intensity (how much time per day) of practice (e. Assessment of mindfulness by self-report: The Kentucky Inventory of Mindfulness Skills. One underdeveloped topic of particular interest involves the long-term effect of mindfulness practice. what is that threshold? Are certain types of clients more likely to respond positively to mindfulness practices? Are specific practices that use mindfulness—from meditation and yoga to Qigong and body scan—more effective for different types of people? How does living mindfully affect counselor self-care. Assessment. 191–206. consistent and disciplined) practice necessary? Some studies have demonstrated lasting positive outcomes as far as 3 years postintervention (Miller et al. L. researchers agree that it should not serve to replace widely used or empirically supported therapies.. How do we ensure that intervention programs are designed and taught by competent people with an adequate understanding of mindfulness practice? Addressing this issue. Baer (2003) pointed out that the literature as a whole does a poor job of assessing and communicating the integrity of these interventions. 142). J. T. 66. research in mindfulness has sparked growing interest. Consequently. intentional (i... 2003). Assessment. References Arch. 1995). and burnout? What is preventing more counseling training programs from implementing mindfulness in their training? What are the best ways to do so? Despite its limitations as an emerging area within the field of counseling. M. in its ability to improve wellbeing across multiple domains? A closer examination of the literature reveals that while mindfulness training indeed seems to be effective in improving well-being and reducing distress. Hopkins. This concern is related to the problem of assessment and measurement: How are we to assess the various dimensions of mindfulness. & Simpson. & Toney. 11. and it seems clear that its application as a counseling intervention is powerful and widely applicable. & Allen. sense of control. females). Mindfulness is seen as the pivotal ingredient. 2011.. mindfulness has demonstrated great promise and warrants further investigation. only one study in a meta-analytic review of 21 MBIs focused on an inner-city or Latino population (Baer... J. Smith. (2004). 125–143. Krietemeyer. However. Ørnbøl. Furthermore. mindfulness is a newcomer in the field of counseling outcome research. One wonders. it is likely most effective for clients when integrated with other counseling approaches. does an 8-week mindfulness training intervention such as MBSR produce lasting change for clients. 1849–1858. (1997). Behavior Research & Therapy. Psychotherapy and Psychosomatics. A. J. akin to cardiovascular exercise. for example. A. few studies have included an ethnically diverse clientele. G. Using self-report assessment methods to explore facets of mindfulness. (2003). Clinical Psychology: Science and Practice. R. There is also a need for studies that compare mindfulness training both to active control conditions and to conventional counseling approaches such as cognitive behavior therapy. Smith. Marquis. to both ascertain comparative effectiveness and discern the “active” ingredients of MBIs. or standards for counselors to use mindfulness skills with their clients. including the integrity of the instruction and each individual clinician’s knowledge and understanding of the practice? Many important questions for future research remain. (2006). researchers should explore the effectiveness of mindfulness training when incorporated into individual counseling sessions. J. 44. While research has not yet unequivocally demonstrated this assertion.. the vast majority of MBI research is conducted with adults ages 18 to 65. 102 Another limitation of the current mindfulness literature is that most articles fail to discuss the qualifications. Baer. the catalyst for a profound change in the way self is experienced” (p. A. T. the self can never be thought of in the same spatially based manner again. operational definitions of the constructs. and reliable assessment tools (Fjorback. Future research is needed to study the effects of mindfulness with more diverse groups of clients. Mindfulness training as a clinical intervention: A conceptual and empirical review.. One explanation. 13. 27–45. & Craske. Mechanisms of mindfulness: Emotion regulation following a focused breathing induction.. 2009). Stress reduction through mindfulness meditation: Effects on psychological symptomatology. Baer. For instance. the effects of mindfulness training tend to hold up quite well when evaluated in follow-up studies. and spiritual experiences.g. compassion fatigue. such as Is there a certain level or threshold of mindfulness practice required for clients or counselors to reap substantial benefits? If so. R. although a great deal of research has been published on the application of mindfulness training to certain specific populations (e. G. training. 2011). Smith.

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