JACM

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 00, Number 00, 2019, pp. 1–16
ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2019.0137

The Many Roads to Mindfulness:

A Review of Nonmindfulness-Based Interventions
that Increase Mindfulness
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Tom Xia, MD,1 Hiroe Hu, BS,2,3 Andreea L. Seritan, MD,4,5 and Stuart Eisendrath, MD4,5

Abstract
Objectives: Mindfulness-based interventions (MBIs) have become increasingly popular for treating various
physical and mental disorders. An increase in mindfulness levels through the teaching of mindfulness medi-
tation is the most well-studied mechanism of MBIs. Recent studies, however, suggest that an increase in
mindfulness is also observed in physical or psychosocial interventions not explicitly labeled as MBIs, or what
the authors call non-MBIs. The authors aimed to review what non-MBIs can increase mindfulness levels despite
not explicitly teaching mindfulness meditation.
Design: The authors conducted a literature search for studies that included a non-MBI study arm measuring
pre- and postintervention mindfulness levels using one of the following eight validated self-reported mind-
fulness questionnaires: Five-Faceted Mindfulness Questionnaire, Mindful Awareness and Attention Scale,
Freiburg Mindfulness Inventory, Toronto Mindfulness Scale, Philadelphia Mindfulness Scale, Kentucky In-
ventory of Mindfulness Skills, Child and Adolescent Mindfulness Measure, and Cognitive and Affective
Mindfulness Scale-Revised. The authors identified 69 non-MBI study arms from 51 independent studies of the
non-MBI itself or as active controls of an MBI under investigation. The authors documented or calculated, if not
provided, effect sizes (ES) for changes in mindfulness levels following these interventions.
Results: Among the 69 non-MBI arms, 36 showed no effect for change in mindfulness (ES <0.20), 3 were
indeterminate (no ES available or unable to calculate), 13 had small effects (0.20 < ES <0.5), 13 had medium
effects (0.50 < ES <0.80), 3 had large effects (0.80 < ES <1.3), and 1 had a very large effect (ES >1.3) for
change in mindfulness.
Conclusions: Analysis of the characteristics of non-MBIs with significant increases in mindfulness levels
suggested some commonalities between MBIs and non-MBIs, shedding light on a spectrum of mindfulness-
related interventions and the possibility that there are many roads to developing mindfulness.

Keywords: mindfulness, meditation, exercise, psychotherapy, review, nonmindfulness-based interventions

Introduction a form of meditation that directs participants to be aware of and

observe their sensations, thoughts, and feelings. This mind-

M indfulness-based interventions (MBIs) have be-

come increasingly popular over the past several decades
as treatment modalities for numerous physical and mental
disorders.1,2 These interventions teach mindfulness meditation
fulness practice is seen as a core component of the therapy to
help patients change their relationship with their illness and
improve quality of life.3 MBIs, such as mindfulness-based
stress reduction (MBSR) and mindfulness-based cognitive

1
Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA.
2
College of Osteopathic Medicine, Touro University California, Vallejo, CA.
3
Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco,
CA.
4
Department of Psychiatry, University of California San Francisco, San Francisco, CA.
5
Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA.

1
 2 XIA ET AL.
therapy ( MBCT), have been shown to decrease symptom
severity and improve well-being in patients with chronic
pain,4 anxiety, depression,2,5,6 and other illnesses, in-
cluding fibromyalgia, multiple sclerosis, and Parkinson’s
disease.7–9
he question of how exactly MBIs work is yet to be an-
swered with scientific precision, although the most studied
mechanism is the increase in mindfulness, defined as ‘‘the
awareness that emerges through paying attention on pur-
pose, in the present moment, and nonjudgmentally to things
as they are in the service of self-understanding and wis-
dom.’’10 Mindfulness can be a state of consciousness or a
personality trait, commonly referred to as ‘‘dispositional
mindfulness.’’11 Practicing state mindfulness more often
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.
and for longer durations is believed to lead to increased
dispositional mindfulness, which is the therapeutic rationale
for MBIs.1
Early studies comparing MBIs to waitlist or non-
psychotherapeutic controls consistently show that along with
other mechanisms of action, increased mindfulness mediates
the therapeutic effects of MBIs.5,12–14 More recent trials have
compared MBIs to active control arms consisting of various
interventions that do not explicitly teach mindfulness prin-
ciples and do not have the goal of increasing levels of
mindfulness, interventions the authors will call non-MBIs.
These non-MBIs typically match the practice time, group
interaction, and intervention duration of that of MBIs.
Interestingly, despite principles of mindfulness only being
taught in the MBI arm, often both intervention and active
control arms show increases in self-reported mindful-
ness.15,16 Moreover, mindfulness has been postulated to be a
personality trait that varies between individuals as certain
people obtain high scores on self-reported measures of dis-
positional mindfulness despite never having practiced mind-
fulness meditation.1,11,17
The authors aim to review the scientific literature to de-
lineate what interventions have been associated with in-
creases in mindfulness aside from formal MBIs. Specifically,
the authors conducted a literature review of studies on non-
MBIs and studies on MBIs with non-MBI control arms that
measured preintervention and postintervention levels of
mindfulness. By discovering and analyzing non-MBIs asso-
ciated with increased mindfulness levels, this study presents a
list of interventions that may offer similar benefits to those of
MBIs through increased mindfulness.
Materials and Methods
The search process
The authors conducted a review of articles in PubMed from
first available (August 2002) to October 2016 using the search
terms: Mindfulness AND ([Five Facet Mindfulness Ques-
tionnaire] FFMQ OR [Mindful Attention and Awareness
Scale] MAAS OR [Freiburg Mindfulness Inventory] FMI
OR [Toronto Mindfulness Scale] TMS OR [Philadelphia
Mindfulness Scale] PHLMS OR [Kentucky Inventory of
Mindfulness Skills] KIMS OR [Child and Adolescent
Mindfulness Measure] CAMM OR [Cognitive and Affective
Mindfulness Scale] CAMS).
These search terms were selected to include the most com-
mon validated instruments that measure mindfulness.11,19–25
In addition, reference lists were inspected for additional
relevant articles that fit the inclusion criteria as described
below. Two authors (T.X. and S.E.) conducted independent
literature searches and then achieved consensus on articles
included.
Definitions
The authors defined an MBI as any intervention in which
the practice of mindfulness meditation was a key compo-
nent. Yoga and t’ai chi were categorized as MBIs are they
are utilized in several MBIs such as MBSR and MBCT.
Interventions without mindfulness meditation as a major
component and not Yoga or t’ai chi were categorized as
non-MBIs.
Inclusion and exclusion criteria
Inclusion criteria were as follows:
1. Studies that measured preintervention and postinter-
vention levels of mindfulness, either state or trait, using
standardized measures, that is, self-reported question-
naires, as mentioned above (FFMQ, MAAS, FMI, TMS,
PHLMS, KIMS, CAMM, CAMS), and
2. Studies that included at least one intervention arm or
active control arm that was defined as a non-MBI
The exclusion criteria are as follows:
1. Studies on MBIs or non-MBI that did not measure pre-
and postintervention levels of mindfulness
2. Studies on MBIs that only used waitlist or treatment-
as-usual (TAU) control and no active non-MBI control
arm.
Data analysis
Pre- and postintervention levels of mindfulness were
documented. Effect sizes (ES) of changes in mindfulness
were documented if reported by the study, otherwise they
were calculated by the equation: Cohen’s d = M1 - M2/
SDpooled whenever the relevant data were available.26 For
non-MBI studies that included at least one arm with an MBI,
similar analyses were performed for MBI arms to compare
ES between MBIs and non-MBIs.
Questionnaires
The descriptors and references to the self-reported ques-
tionnaires used in their literature research are summarized in
Table 1 with notable exceptions listed in the comments
column. Most of these questionnaires measure dispositional
mindfulness, with the exception of the TMS, which mea-
sures state mindfulness.21 The questionnaires that measure
dispositional mindfulness are further divided into ones that
are unidimensional (single scoring system) or multidimen-
sional (both composite and individual subscale scoring are
reported). The KIMS, FFMQ, and PHLMS are multidi-
mensional trait mindfulness measures, whereas the MAAS,
FMI, and CAMS are unidimensional.
Most questionnaires are designed for adults, with or
without previous meditation experiences, with exceptions
noted in the comments column for the FMI and CAMM.
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 1. Characteristics of Self-Reported Questionnaires that Measure Mindfulness

Cronbach’s
Questionnaire Items Scale Scoring Subscales alpha Comments References
18
Five Facet Mindfulness 39 5-point Composite and (1) Observe 0.75–0.91
Questionnaire Likert Individual (2) Describe
(FFMQ) subscale scoring (3) Act with awareness
(4) Nonjudging
(5) Nonreactivity
11
Mindful Attention and Awareness 15 6-point Single scoring None 0.82
Scale (MAAS) Likert
20
Freiburg Mindfulness Inventory (FMI) 30 4-point Single scoring None 0.93–0.94 Designed for experienced
Likert meditators
21
Toronto Mindfulness Scale (TMS) 13 5-point Composite and (1) Curiosity 0.91–0.93 Measures immediate

3
Likert Individual (2) Decentering experience after meditation
subscale scoring (i.e., state mindfulness)
22
Philadelphia Mindfulness Scale 20 5-point Composite and (1) Awareness 0.81–0.85
(PHLMS) Likert Individual (2) Acceptance
subscale scoring
23
Kentucky Inventory of Mindfulness 39 5-point Composite and (1) Observe 0.76–0.91
Skills (KIMS) Likert Individual (2) Describe
subscale scoring (3) Accept without
judgment
(4) Act with awareness
24
Child and Adolescent Mindfulness 10 5-point Single scoring None 0.80 For school-age children
Measure (CAMM) Likert and adolescents
25
Cognitive and Affective Mindfulness 12 4-point Single scoring None 0.74–0.80
Scale-Revised (CAMS-R) Likert
 4 XIA ET AL.
Internal consistencies (calculated as Cronbach’s Alpha) for
all questionnaires are summarized in Table 1.
Results
Literature search
Their search terms returned 1890 articles, and 51 studies
were found to meet their inclusion criteria. The vast ma-
jority of studies that returned on their search terms involved
studying MBIs either without controls or with only a waitlist
or TAU controls. As such, they were excluded from their
study due to not having a non-MBI arm. Studies that had
non-MBI arms but did not report pre- and postintervention
levels of mindfulness or only measured partial levels of
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.
mindfulness (utilizing certain subscales within a mindful-
ness self-reported questionnaire) were also excluded.
Study characteristics
The 51 studies that met the inclusion criteria fell into one
of two categories:
1. Seventeen studies investigated the pre- and post-
intervention levels of mindfulness during a non-MBI.
These studies did not have a comparison MBI group.
2. Thirty-four studies investigated the pre- and post-
intervention levels of mindfulness during a single
MBI, compared with one or more non-MBIs that
served as the active control.
Sample size ranged from 16 to 282, with a total of 4690
participants. The combined 51 studies incorporated 69 total
non-MBI modalities, which ranged from aerobic exercise
to muscle relaxation, equine therapy, and art therapy, as
summarized in Tables 2 and 3. Non-MBIs were performed
with various individuals, either medically healthy or suf-
fering from anxiety disorders, chronic pain, major depres-
sive disorder, psychosis, insomnia, substance use, or
obesity. Studies also included participants of different ages,
ranging from age 9 to 88 (Tables 2 and 3).
Change in mindfulness levels after MBIs and non-MBIs
The authors paid particular attention to the change in
mindfulness levels as a result of these 69 non-MBI modal-
ities, either as stand-alone study (Table 2) or used as active
control in an MBI study (Table 3). Among the 69 non-MBIs,
36 showed no effect for change in mindfulness (ES <0.20), 3
were indeterminate (unreported ES and unable to calculate),
13 had small effects (0.20 < ES <0.5), 13 had medium ef-
fects (0.50 < ES <0.80), three demonstrated large effects
(0.80 < ES <1.3), and 1 had a very large effect (ES >1.3).
The one intervention with very large effect for increased
mindfulness was the group hiking trip for 14-year-old
children.27 The three interventions that demonstrated large
effects were equine-assisted therapy for PTSD patients,28
loving kindness meditation for veterans with PTSD,29 and
physical exercise for young adults with elevated stress.30
The 13 interventions with medium effect for increased
mindfulness were Pilates for college students,31 both in-
person and Internet-delivered intensive short-term dynamic
psychotherapy for people with medically unexplained
pain,32,33 web-based happiness training for healthy work
employees,34 wilderness excursion for university students,27
heart coherence training for patients with chronic muscu-
loskeletal pain (but not healthy adults),35 self-help inter-
ventions for people with high neuroticism,36 heart rate
variability biofeedback for young adults with elevated stress
levels,30 health enhancement program for patients with
treatment resistant depression,15 health education program
modeled on ‘‘10 keys’’ of healthy aging for older adults with
chronic low back pain,37 reading for healthy pregnant
women,38 mind–body bridging for cancer survivors,39 and a
diet-exercise program for obese individuals.40
Finally, the 13 interventions that showed a small effect
were mantram repetition for veterans with PTSD,41 gyro-
kinesis for college students,42 Aikido for university stu-
dents,43 exercise training for sedentary healthy males,44
affect-consciousness training for patients with psychosis,45
cognitive behavioral therapy (CBT) for insomnia for cancer
survivors with insomnia,46 aerobic exercise for patients with
generalized social anxiety disorder,47 cognitive behavioral
group therapy for patients diagnosed with social anxiety
disorder,48 food construal messages for college students,49
behavioral activation for depressed college students,50 tango
for people with self-declared depression,51 supportive ex-
pressive group therapy for distressed breast cancer survi-
vors,52 and the eight point program involving mantram
meditation for college students.53
Discussion
The present study was undertaken to answer an important
question in mindfulness research: do non-MBIs (and which
ones specifically) increase mindfulness levels? Their find-
ings strongly suggest that certain non-MBIs can indeed have
a significant effect on increasing mindfulness in a wide
range of both nonclinical and clinical participants. In fact,
30 of the 69 non-MBIs showed at least a small effect for
increase in mindfulness (Tables 2 and 3). With high dropout
rates being an issue in meditation-related interventions and
research suggesting that more individualized modalities may
be beneficial, non-MBIs may offer people unaware, unin-
volved, or uninterested in traditional MBIs the opportunity
to reap the same benefits of developing mindfulness.54
The non-MBIs researched ranged from interventions that
share much overlap with MBIs (other forms of medita-
tion, mind–body interventions) to interventions traditionally
thought of as unrelated to mindfulness. Not surprisingly,
nonmindfulness forms of meditation were associated with
increased mindfulness levels. Mantram meditation utilizes
attention to specific sounds or phrases to concentrate the
mind, and loving-kindness meditation may use repeated
phrases to cultivate compassion and benevolence.29,41,53
Although these forms of meditation and mindfulness
meditation may differ in goals and specific techniques, their
shared attention regulation may have contributed to the fact
that all three practices are associated with increased mind-
fulness levels. In fact, functional neuroimaging studies show
activity in common brain areas consistently among distinct
forms of meditation.55
Also expected was that many of the non-MBIs associated
with increased mindfulness were mind–body practices, in-
terventions where a major component of the practice is di-
recting mental awareness to the body, breath, or movement
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 2. Characteristics of Studies on Nonmindfulness-Based Interventions

Preintervention Postintervention
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Bormann et al. Veterans with PTSD Mantram repetition program MAAS 71 47.5 51.6** 0.46 Mantram repetition program
(2014)41 group had greater increase
in mindful attention, which
mediated improvements in
PTSD symptoms, depression,
and improved psychologic
well-being
TAU 70 48.1 46.4
Burton et al. Patients with social Virtual reality MAAS 32 4.12 4.03 -0.09 Both groups were associated
(2013)80 anxiety disorder with decreased fear of
negative evaluation
Exposure therapy group 33 3.95 4.03 0.08
Caldwell et al. Undergraduate students Pilates method FFMQ 169 131 140* NR Only the Pilates group had
(2013)31 recreational exercise class 139 131 131 NR increase in mindfulness
scores and increases related
to self-efficacy, perceived
stress, and mood
Chavooshi People with unexplained In-person intensive short-term MAAS 42 35.4 45.1*** 0.75 The in-person group had lower
et al. (2017)33 pain dynamic psychotherapy pain intensity, depression,

5
Internet-delivered intensive 39 33.2 31.3 -0.14 anxiety, and stress and greater
short-term dynamic increase in emotional regulation
psychotherapy functioning, mindfulness, and
quality of life
Chavooshi Patients with medically Internet delivered intensive MAAS 50 36.8 45.1** 0.54 The ISTDP group showed
et al. (2016)32 unexplained pain short-term dynamic reduced pain symptoms,
psychotherapy (ISTDP) depression, anxiety, stress,
and increased emotion regulation
functioning, mindfulness, and
quality of life
TAU 50 35.2 31.3 -0.27
Chesak et al. New nurses Stress-management and MAAS 19 4.42 4.57 0.19 The SMART group showed
(2015)56 resiliency training increased mindfulness and
(SMART) resilience, as well as decreased
stress and anxiety, but was not
significantly different than
controls
Stress education 21 3.85 3.80 -0.09
Earles et al. Patients with PTSD Equine-assisted therapy FFMQ 16 110 123*** 1.28 Patients after EAT showed
(2015)28 (EAT) decreased PTSD symptoms,
less severe emotional response
to trauma, less anxiety, and
fewer symptoms of depression
(continued)
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 2. (Continued)
Preintervention Postintervention
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Feicht et al. Work employees Web-based happiness training FMI 54 35.9 39.5** 0.54 The happiness training group
(2013)34 showed improvement in
happiness, satisfaction,
quality of life, mindfulness,
flourishing, and recovery
experience while decreasing
perceived stress
Waitlist 47 35.0 35.2 0.03
Kearney et al. Veterans with PTSD Loving kindness meditation FFMQ 42 106 125* 0.80 Loving kindness meditation
(2013)29 group showed decreased
PTSD and depression symptoms
Leong et al. Patients with major Repetitive transcranial FFMQ 32 111 114 Patients that received rTMS
(2013)57 depressive episode magnetic stimulation showed decreases in depression
(rTMS) and anxiety and increases in
nonreactivity of FFMQ and
decentering of Experiences

6
Questionnaire.
Lothes et al. University students with Aikido KIMS 12 135 142 0.48 Aikido training was associated
(2013)43 no previous martial with increased mindfulness
arts training scores
No intervention control KIMS 20 126 121 -0.42
Aikido MAAS 12 67.0 72.0 0.19
No intervention control MAAS 20 56.0 52.0 -0.26
Moore et al. College students Writing repeated traumatic KIMS 159 122 119 -0.22 Neither group showed changes
(2009)58 narratives in mental health or
Writing unemotional daily 74 122 122 0 experiential avoidance
event narratives after the intervention
Mothes et al. Sedentary healthy males Exercise training + MAAS 40 4.45 4.57* 0.28 Dispositional mindfulness
(2014)44 relaxation training 41 4.34 4.27 0.19 increased in exercise group
but not relaxation or waitlist
groups and were moderately
correlated with improvements
in mental health
Waitlist 37 4.51 4.49 -0.03
(continued)
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 2. (Continued)
Preintervention Postintervention
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Mutz and 14 Year olds Group hiking trip MAAS 12 4.41 4.81*** 1.32 Participants had increased
Muller mindfulness and life
(2016)27 satisfaction and decreased
demand of Perceived Stress
Questionnaire
University students Wilderness excursion MAAS 15 3.93 4.18* 0.54 Participants had increased
mindfulness, life satisfaction,
happiness, self-efficacy,
and decreased perceived stress
Control 7 4.15 4.14 -0.02
Potash et al. Health care workers in Art therapy–based supervision FFMQ 56 116 116 0 Art-therapy based supervision

7
(2014)59 the field of death, group group showed decrease in
dying, and Skill-based supervision group 57 115 116 0.10 exhaustion and death anxiety
bereavement and increase in emotional
awareness
Soer et al. Patients with chronic Heart coherence training MAAS 10 53.0 55.0 0.60 Both groups had increase in
(2015)35 musculoskeletal pain FFMQ 10 135 135 0.40 heart coherence scores
Healthy people Heart coherence training MAAS 15 62.0 58.0 -0.40 but effect sizes for change
FFMQ 15 129 134 0.10 on MAAS and FFMQ
were low
Soler et al. Healthy people Ayahuasca psychedelic brew FFMQ 25 137 146* NR Plant intake led to increase
(2016)60 in two mindfulness facets,
as well as decentering
*p < 0.05, **p < 0.01, ***p < 0.001.
FFMQ, Five Facet Mindfulness Questionnaire; FMI, Freiburg Mindfulness Inventory; KIMS, Kentucky Inventory of Mindfulness Skills; MAAS, Mindful Attention and Awareness Scale; NR, not
reported; PTSD, post-traumatic stress disorder; TAU, treatment-as-usual.
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 3. Characteristics of Studies Comparing Mindfulness-Based Interventions to Nonmindfulness-Based Interventions

Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Armstrong and People with high Mindfulness-based cognitive FFMQ 17 108 133*** 1.25 MBCT group had lower
Rimes (2016)36 neuroticism therapy (MBCT) neuroticism, reduced
rumination, and increased
self-compassion and decentering
compared to control
Self-help interventions 17 102 116* 0.73
Banks et al. Healthy adults Home mindfulness meditation FFMQ 40 130 132 0.16 Mindfulness meditation
(2015)61 failed to increase memory
or decrease mind wandering
but decreased stress related
working memory impairments
Muscle relaxation and body scan 40 124 126 0.15
Bergen-Cico Undergraduate students Mindfulness-based stress KIMS 72 126 133* 0.36 MBSR group showed
et al. (2013)62 reduction (MBSR) improvements in mindfulness
Class w/discussion about mindful 47 123 123 0.03 and self-compassion
and present centered awareness compared to control class
MBSR PHLMS 72 64.9 67.5 0.43
Class w/discussion about mindful 47 63.2 63.1 -0.01
and present centered awareness

8
Bieling et al. MDD patients in MBCT TMS 18 9.93 13.2 0.47 The MBCT group showed
(2012)63 remission curiosity increased decentering and
wider experiences compared
to controls
Medication 14 13.3 11.1 -0.51
Placebo 15 11.6 10.0 -0.25
MBCT TMS 18 13.5 19.7* 0.90
decentering
Medication 14 16.7 14.1 -0.57
Placebo 15 12.4 12.0 -0.07
Britton et al. Healthy sixth-grade Asian history course w/daily CAMS-R 33.0 33.0 0 Both groups had decreased
(2014)64 students mindfulness meditation practice scores on Youth Self-Report
African history course with 32.9 32.6 0 and CAMS-R, but meditators
matched experiential activity were less likely to develop
suicidal ideation or thoughts
of self-harm
de Bruin et al. Young adults with Mindfulness meditation FFMQ 27 77.9 83.7 0.27 All three interventions were
(2016)30 elevated stress Physical exercise 25 74.6 82.8** 0.99 equivalent in improving
levels Heart rate variability 23 77.3 83.7* 0.68 attention control, executive
biofeedback+ functioning, mindful
awareness, self-compassion,
and worrying
(continued)
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Caldwell et al. College students Taiji Quan FFMQ 38 131 139 0.42 All groups were showed
(2010)42 increase in mindfulness
and improved sleep
Pilates 80 130 139*** 0.54
Gyrokinesis 48 128 132 0.27
Chiesa et al. Depressed patients who MBCT MAAS 9 3.16 2.98 -0.20 The MBCT group showed
(2012)65 did not achieve significantly improved
remission after 8 weeks scores in depression and
of antidepressants psychologic general well-being
Psycho-education 7 2.44 3.42 0.72
Chiesa et al. Patients with MDD who MBCT FFMQ 23 117 128* 0.76 MBCT had higher improvements
(2015)66 did not achieve Psycho-educational control 20 120 121 0.05 in depression scores,
remission after as well as quality of life
antidepressant and mindfulness
treatment
Eisendrath Patients with treatment MBCT FFMQ 87 107 126*** 0.89 MBCT showed greater
et al. (2016)15 resistant depression Health enhancement program 86 109 122*** 0.55 depression reduction and
(HEP) response and equal remission
rates compared to HEP

9
Eliassen et al. Patients with psychoses MBSR FFMQ 27 141 143 0.17 Both interventions improved
(2016)45 Affect-consciousness training 23 142 146 0.38 ward atmosphere
Garland et al. Cancer survivors with mindfulness-based cancer FFMQ 32 129 130 0.09 Both CBT-I and MBCR reduced
(2014)46 insomnia recovery (MBCR) insomnia severity
Cognitive behavior therapy 40 128 132 0.42
for insomnia (CBT-I)
Garland et al. Men with substance use, MORE FFMQ 64 125 139** 0.53 MORE showed greater
(2016)67 psychiatric disorders, Cognitive-behavioral therapy 64 130 130 -0.01 improvement in substance
or trauma histories (CBT) craving, post-traumatic stress,
TAU 52 127 129 0.10 and negative effect than CBT
Goldberg et al. Healthy people without MBSR FFMQ 34 107 116** 0.54 FFMQ facets correlated with
(2016)68 meditation experience HEP 36 113 122*** 0.66 psychosocial symptoms
Waitlist 36 107 111* 0.24 and well-being, and both
facets increased in both MBSR
and HEP relative to controls
Goldin et al. Patients with generalized MBSR KIMS 31 111 127* 1.12 MBSR produced larger decreases
(2012)47 social anxiety disorder Aerobic exercise 26 111 118 0.45 in negative self-views and
similar increases in positive
self-views
(continued)
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Guardino et al. Pregnant women Mindful awareness practices FFMQ 24 120 134*** 1.02 Both groups had increased
(2014)38 classes (MAPS) mindfulness and decreased
Reading 23 124 135* 0.69 perceived stress and state
anxiety, but the MAPS
group had larger decreases
in pregnancy specific anxiety
Hou et al. Caregivers of persons MBSR FFMQ 70 123 125 0.11 MBSR group had greater decrease
(2014)69 with chronic in depressive and anxiety
conditions symptoms and greater increase
in self-efficacy and mindfulness.
Self-help booklet for health 71 119 118 0.08
education
Kingston et al. Healthy university Mindfulness session KIMS 21 3.06 3.29* 0.76 Pain tolerance increased only
(2007)70 students in the mindfulness group,
and diastolic blood pressure
decreased in both groups
Guided visual imagery session 21 3.23 3.26 0.09
Kocovski et al. Patients diagnosed with mindfulness and acceptance- FMI 53 29.0 32.8** 0.35 MAGT and CBGT were equally
(2013)48 social anxiety disorder based group therapy better than control at reducing

10
(MAGT) social anxiety
cognitive behavioral group 53 29.4 31.5 0.26
therapy (CBGT)
Waitlist 31 30.4 30.4 0.01
Lipschitz et al. Cancer survivors Mindfulness meditation FFMQ 11 125 135 0.42 Mindfulness meditation and
(2015)38 MBR groups had greater
reduction in sleep problems
than SHE
Mind–body bridging (MBR) 10 129 142 0.79
Sleep hygiene education (SHE) 9 135 130 -0.21
Mantzios and Undergraduate students Meditation MAAS 50 3.99 4.22 0.29 At the end of intervention,
Wilson (2014)49 Food construal 48 3.61 3.85 0.29 weight loss was equal for
both groups, but food
construal diaries performed
better at 3-month follow-up
Mason et al. Obese individuals Mindfulness-based weight loss MEQ 78 2.70 2.90*** 0.57 The mindfulness group had
(2016)40 intervention increased mindful eating
and maintenance of fasting
glucose compared to the
active control
Diet-exercise program+ 76 2.60 2.80*** 0.57
(continued)
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
McClintock Adults with high levels Mindfulness therapy for FFMQ 24 120 144*** 1.21 MT-MID group showed
et al. of maladaptive maladaptive interpersonal improvements in
(2015)71 dependency dependency (MT-MID) interpersonal dependency
compared to controls
Writing article summaries of 24 112 112 -0.02
research articles
McIndoo et al. Depressed college Individual MBSR FFMQ 20 108 120* 0.68 Both groups had
(2016)50 students Behavioral activation 16 110 113 0.23 improvements in
Waitlist 14 109 109 -0.01 depression, rumination,
stress, and mindfulness
relative to controls
Morone et al. Older adults with chronic Mind–body program modeled MAAS 140 4.60 4.50 -0.14 Mind–body program
(2016)37 low back pain after MBSR improved function short-term
Health education program 142 4.40 4.50 0.14 and pain long-term but not
modeled on ‘‘10 keys’’ of function long-term
healthy aging
Noggle et al. Grade 11 or 12 students Yoga CAMM 36 53.9 53.4 -0.06 Yoga group showed improved
(2012)72 total mood disturbance, while
physical exercise showed

11
worsened mood disturbance
Physical exercise 15 52.3 49.4 -0.42
Pinniger et al. People with self-declared Meditation MAAS 16 3.51 3.81 0.34 Depression was reduced in tango
(2012)51 depression Tango 21 3.71 4.13 0.32 and meditation groups and
Waitlist 29 3.31 3.45 0.17 stress was reduced only in
tango
Robins et al. Women with increased t’ai chi MAAS 31 3.95 4.24 0.33 t’ai chi group had decreased
(2015)73 risk of cardiovascular fatigue, granulocyte colony
disease stimulating factor, interferon
gamma, tumor necrosis factor,
interleukin 8, and interleukin 4
Waitlist 32 3.79 3.77 -0.02
Schellekens Distressed breast cancer Mindfulness based cancer MAAS 69 3.81 4.16* 0.38 MBCR group had greater
et al. survivors recovery (MBCR) improvement in mood
(2017)52 Supportive expressive group 70 3.88 4.04 0.21 disturbance, stress symptoms,
therapy (SET) and social support but not
quality of life or mindfulness
compared to SET
Schmidt et al. Females with MBSR FMI 53 36.4 37.7 0.23 Only MBSR group had modest
(2011)74 fibromyalgia improvement in quality of life
Muscle relaxation and stretching 56 35.9 35.1 -0.09
waitlist 59 36.7 36.1 -0.08
(continued)
 Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.

Table 3. (Continued)
Pretest Post-test
mindfulness mindfulness Effect
Study (year) Population Intervention Scale N level level size Primary study findings
Schonert-Reichl Elementary school Mindfulness-based emotional MAAS-C 48 4.34 4.68* 0.42 The mindfulness group showed
et al. (2015)75 children learning greater improvements in
cognitive control, stress
physiology, empathy,
perspective-taking, emotional
control, optimism, school self-
concept, and mindfulness, as
well as greater decreases in
depression and aggression
Social responsibility program 51 4.56 4.26 -0.40
Shapiro et al. Undergraduate college MBSR MAAS 15 53.3 60.4 0.55 Both groups were associated
(2008)53 students with increased mindfulness
and mindfulness mediated
decreased stress and
rumination
Eight point program—mantram 14 54.7 59.2 0.33
meditation
Silverstein et al. College women Meditation course and practice FFMQ 14 124 140** 1.28 The meditation group was faster
(2011)76 at registering physiologic

12
responses to sexual stimuli,
had improved attention, self-
judgment, anxiety symptoms,
and depression
Religious studies course 16 133 135 0.20
Meditation course and practice MAAS 14 3.80 4.30* 1.00
Religious studies course 16 4.10 4.00 -0.25
Smith et al. Healthy adults MBSR MAAS 36 3.68 4.12* 0.49 MBSR had better outcomes in
(2008)77 mindfulness, energy, pain, and
a trend for binge eating
Cognitive-behavioral stress 14 4.30 3.75 -0.55
reduction
Zeidan et al. Healthy college students Mindfulness meditation FMI 24 43.4 50.0* 0.70 Both groups had improved
(2010)78 mood, but only the meditation
group showed reduced fatigue,
anxiety, and increased mindfulness
Group audiobook listening 25 47.0 48.4 0.16
*p < 0.05, **p < 0.01, ***p < 0.001.
CAMS-R, Cognitive and Affective Mindfulness Scale- Revised; CAMM, Child and Adolescent Mindfulness Measure; FFMQ, Five Facet Mindfulness Questionnaire; FMI, Freiburg Mindfulness
Inventory; KIMS, Kentucky Inventory of Mindfulness Skills; MAAS, Mindful Attention and Awareness Scale; MAAS-C, Mindful Attention and Awareness Scale-Children; MBCT, Mindfulness-based
Cognitive Therapy; MBSR, Mindfulness-based Stress Reduction; MEQ, Mindful Eating Questionnaire; PHLMS, Philadelphia Mindfulness Scale; TAU, treatment-as-usual; TMS, Toronto Mindfulness
Scale.
 REVIEW OF NONMINDFULNESS-BASED INTERVENTIONS
despite not having a formal mindfulness meditation teaching
component (Tables 2 and 3). These mind–body interven-
tions, such as Pilates, mind–body bridging, gyrokinesis, and
heart-coherence training, at times demonstrated similar in-
creases in mindfulness to MBIs.39 These results make sense
as mind–body practices not only direct attention to the body
and breath similarly to mindfulness meditation but also play
a role in many MBIs either as mindful movement or
yoga.2,5,6
Interestingly, regular exercises not considered mind–body
practices were associated with increased mindfulness levels
as well. In fact, 22 of the 69 non-MBI arms included some
form of exercise, such as aerobics, wilderness hikes, recre-
ational exercise, and tango (Tables 2 and 3). Interventions
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.
such as physical exercise for young adults with elevated
stress levels30 and a group hiking trip for 14-year-old
healthy boys27 were associated with some of the greatest
increases in mindfulness among all interventions.
How these interventions without formal mindfulness train-
ing can lead to such large increases in ES remains to be
understood. One explanation could be that physical exercise
results in conscious somatosensory cognizance of body
movements, in turn leading to attention regulation and higher
body awareness.79 It is possible that this heightened attention
and awareness translate into increased mindfulness.
Given these results, it seems likely that mindfulness op-
erates on a spectrum and the somewhat arbitrary categori-
zations of MBI, mind–body, or other intervention share
much overlap. While some people require dedicated mind-
fulness meditation to improve mindfulness, others may de-
velop such skills through awareness-based movement or just
ordinary activities (Tables 2 and 3). Interventions such as
tango and Aikido blur the lines between mind–body inter-
vention and other non-MBIs as they may be considered
mere exercise to some people but a more purposeful or even
contemplative practice to others. With this mindfulness
spectrum concept, the authors hope to illuminate the fact
that interventions not traditionally associated with mind-
fulness have a place on this spectrum and have the potential
to help develop mindfulness.
The delivery method of non-MBIs appears to moderate
changes in mindfulness levels as well. Burton et al. found
that exposure group therapy was associated with increased
mindfulness levels in patients with social anxiety disorder,
but a simulation using virtual reality did not produce similar
effects.80 Similarly, Chavooshi et al. found that in-person
intensive short-term dynamic psychotherapy produced a
medium effect of increased mindfulness, but the Internet-
delivered version of the same therapy was not associated
with any changes in mindfulness.32 In both studies, the in-
tervention arms differed only in how the specific therapies
were delivered, group therapy versus virtual reality and in-
person therapy versus Internet-delivered therapy.
Finally, participant selection may have influenced the
changes in mindfulness levels as well. The non-MBI studies
and MBI studies with non-MBI control arms were per-
formed with many different participants, ranging from
school aged children to older adults, some healthy and some
with numerous medical conditions (Tables 2 and 3). Soer
et al. measured the effect of heart coherence training on
mindfulness, and it included both patients with chronic
musculoskeletal pain and healthy adults.35 The same inter-
13
vention had a medium effect of increasing mindfulness in
the patients but no effect on healthy people. It is possible
that medically ill patients are more sensitive to mindfulness-
developing interventions or more motivated to participate in
nonpharmacologic approaches.
The present investigation is limited by the great variation
of studies reviewed. The non-MBIs reviewed differed in
demographics, practice length, level of supervision, scales
used to measure mindfulness levels, and many other non-
specific factors. As previously mentioned, the line between
MBIs and non-MBIs is not well defined, and it seems almost
inevitable that some instructors of non-MBIs (such as CBT
or physical exercise) may teach in a mindful, awareness-
focused way. While the authors argue that mindfulness in-
terventions lie on a spectrum, it becomes difficult to draw
further conclusions from their data due to overlapping
groups. Future studies will be needed to understand the
mechanism that pervades all interventions on this mindful-
ness spectrum.
With regards to mindfulness scales, one scale measured
state mindfulness while the remainder assessed trait mind-
fulness (Table 1). Some scales were multidimensional,
measuring multiple subscale components of mindfulness,
and some were unidimensional (Table 1). Even among the
multidimensional scales like the FFMQ, PHLMS, and
KIMS, different subscales were used (Table 1). Although
their review documents preintervention and postintervention
levels of mindfulness, the variation in mindfulness scales
makes it possible that these studies are not measuring the
same entity. In fact, Aikido was associated with a small
effect (ES 0.48) of change in mindfulness when measured
by the MAAS but no effect (ES 0.19) when using the
KIMS.43
In addition, insufficient information was available re-
garding the information presented to study participants
during the consent process; as such, it is difficult to ascertain
if the control group interventions were presented as non-
mindfulness interventions to participants. This could have
influenced the participants’ expectations and perceptions
regarding the control group interventions, and it may have
affected their self-reporting of mindfulness levels. Studies
have also shown that meditators and nonmeditators assess
their levels of mindfulness differently, further implicating
self-report questionnaires as limited tools for measuring
mindfulness.81,82
A potential solution to this problem is incorporating more
objective measures of mindfulness83 in addition to self-
reported questionnaires to accurately capture all the com-
ponents of mindfulness. Objective measures, such as using
breath counting, electroencephalography, and functional
magnetic resonance imaging, and using one standardized
measurement tool may further their understanding of
mindfulness as a construct.83–85
Conclusions
A broad spectrum of non-MBIs, ranging from various
meditations to exercise and psychotherapies, has been
shown to increase mindfulness levels. Although they do not
directly teach mindfulness meditation, these strategies may
impart skills similar to those taught by MBIs and thus
benefit people who do not participate in structured
 14
mindfulness practices. With so many non-MBIs that in-
crease mindfulness levels, it seems that mindfulness medi-
tation is one of many paths to improving mindfulness, one
of many roads leading to the same destination. Future
studies should explore the mechanisms through which non-
MBIs achieve this effect and strive to find the common
denominator across MBIs and non-MBIs that increase
mindfulness levels.
Ethics Approval
This article does not contain any studies with human
participants or animals performed by any of the authors.
Author Disclosure Statement
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.
No competing financial interest exists.
References
1. Kabat-Zinn J. Mindfulness-based interventions in context:
Past, present, and future. Clin Psychol Sci Pract 2003;10:
144–156.
2. Teasdale JD, Segal ZV, Williams JMG, et al. Prevention of
relapse/recurrence in major depression by mindfulness-
based cognitive therapy. J Consult Clin Psychol 2000;68:
615–623.
3. Kabat-Zinn J. An outpatient program in behavioral medi-
cine for chronic pain patients based on the practice of
mindfulness meditation: Theoretical considerations and
preliminary results. Gen Hosp Psychiatry 1982;4:33–47.
4. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of
mindfulness-based stress reduction vs cognitive behavioral
therapy or usual care on back pain and functional limita-
tions in adults with chronic low back pain: A randomized
clinical trial. JAMA 2016;315:1240–1249.
5. Kuyken W, Warren FC, Taylor RS, et al. Efficacy of
mindfulness-based cognitive therapy in prevention of de-
pressive relapse: An individual patient data meta-analysis
from randomized trials. JAMA Psychiatry 2016;73:565–574.
6. Hofmann SG, Sawyer AT, Witt AA, et al. The effect of
mindfulness-based therapy on anxiety and depression: A meta-
analytic review. J Consult Clin Psychol 2010;78:169–183.
7. Baer RA. Mindfulness training as a clinical intervention: A
conceptual and empirical review. Clin Psychol Sci Pract
2003;10:125–143.
8. Fitzpatrick L, Simpson J, Smith A. A qualitative analysis of
mindfulness-based cognitive therapy (MBCT) in Parkin-
son’s disease. Psychol Psychother 2010;83:179–192.
9. Hoogerwerf AEW, Bol Y, Lobbestael J, et al. Mindfulness-
based cognitive therapy for severely fatigued multiple
sclerosis patients: A waiting list controlled study. J Rehabil
Med 2017;49:497–504.
10. Kabat-Zinn J. Mindfulness. Mindfulness 2015;6:1481–
1483.
11. Brown KW, Ryan RM. The benefits of being present:
Mindfulness and its role in psychological well-being. J Pers
Soc Psychol 2003;84:822–848.
12. Gu J, Strauss C, Bond R, et al. How do mindfulness-based
cognitive therapy and mindfulness-based stress reduction
improve mental health and wellbeing? A systematic review
and meta-analysis of mediation studies. Clin Psychol Rev
2015;37:1–12.
13. Michalak J, Heidenreich T, Meibert P, et al. Mindfulness
predicts relapse/recurrence in major depressive disorder
XIA ET AL.
after mindfulness-based cognitive therapy. J Nerv Ment Dis
2008;196:630–633.
14. Shahar B, Britton WB, Sbarra DA, et al. Mechanisms of
change in mindfulness-based cognitive therapy for de-
pression: Preliminary evidence from a randomized con-
trolled trial. Int J Cogn Ther 2010;3:402–418.
15. Eisendrath SJ, Gillung E, Delucchi KL, et al. A randomized
controlled trial of mindfulness-based cognitive therapy for
treatment-resistant depression. Psychother Psychosom 2016;
85:99–110.
16. Williams JM, Crane C, Barnhofer T, et al. Mindfulness-
based cognitive therapy for preventing relapse in recurrent
depression: A randomized dismantling trial. J Consult Clin
Psychol 2014;82:275–286.
17. Creswell JD, Way BM, Eisenberger NI, et al. Neural cor-
relates of dispositional mindfulness during affect labeling.
Psychosom Med 2007;69:560–565.
18. Christopher MS, Neuser NJ, Michael PG, Baitmangalkar A.
Exploring the psychometric properties of the five facet
mindfulness questionnaire. Mindfulness 2012;3:124–131.
19. Baer RA, Smith GT, Hopkins J, et al. Using self-report
assessment methods to explore facets of mindfulness. As-
sessment 2006;13:27–45.
20. Walach H, Buchheld N, Buttenmüller V, et al. Measuring
mindfulness—the Freiburg Mindfulness Inventory (FMI).
Pers Individ Dif 2006;40:1543–1555.
21. Lau MA, Bishop SR, Segal ZV, et al. The Toronto mind-
fulness scale: Development and validation. J Clin Psychol
2006;62:1445–1467.
22. Cardaciotto L, Herbert JD, Forman EM, et al. The assess-
ment of present-moment awareness and acceptance: The
Philadelphia mindfulness scale. Assessment 2008;15:204–
223.
23. Baer RA, Smith GT, Allen KB. Assessment of mindfulness
by self-report: The Kentucky inventory of mindfulness
skills. Assessment 2004;11:191–206.
24. Greco LA, Baer R, Smith GT. Assessing mindfulness in
children and adolescents: Development and validation of
the child and adolescent mindfulness measure (CAMM).
Psychol Assess 2011;23:606–614.
25. Feldman G, Hayes A, Kumar S, et al. Mindfulness and
emotion regulation: The development and initial validation
of the cognitive and affective mindfulness scale-revised
(CAMS-R). J Psychopathol Behav Assess 2006;29:177–190.
26. Rice ME, Harris GT. Comparing effect sizes in follow-up
studies: ROC area, Cohen’s d, and r. Law Hum Behav
2005;29:615–620.
27. Mutz M, Muller J. Mental health benefits of outdoor ad-
ventures: Results from two pilot studies. J Adolesc 2016;
49:105–114.
28. Earles JL, Vernon LL, Yetz JP. Equine-assisted therapy for
anxiety and posttraumatic stress symptoms. J Trauma
Stress 2015;28:149–152.
29. Kearney DJ, Malte CA, McManus C, et al. Loving-
kindness meditation for posttraumatic stress disorder: A
pilot study. J Trauma Stress 2013;26:426–434.
30. de Bruin EI, van der Zwan JE, Bogels SM. A RCT com-
paring daily mindfulness meditations, biofeedback exer-
cises, and daily physical exercise on attention control,
executive functioning, mindful awareness, self-compassion,
and worrying in stressed young adults. Mindfulness 2016;7:
1182–1192.
31. Caldwell K, Adams M, Quin RH, et al. Pilates, mindfulness
and somatic education. J Dance Somat Pract 2013;5:141–153.
 REVIEW OF NONMINDFULNESS-BASED INTERVENTIONS
32. Chavooshi B, Mohammadkhani P, Dolatshahee B. Efficacy
of intensive short-term dynamic psychotherapy for medi-
cally unexplained pain: A pilot three-armed randomized
controlled trial comparison with mindfulness-based stress
reduction. Psychother Psychosom 2016;85:123–125.
33. Chavooshi B, Mohammadkhani P, Dolatshahee B. Tele-
medicine vs. in-person delivery of intensive short-term
dynamic psychotherapy for patients with medically unex-
plained pain: A 12-month randomized, controlled trial. J
Telemed Telecare 2017;23:133–141.
34. Feicht T, Wittmann M, Jose G, et al. Evaluation of a seven-
week web-based happiness training to improve psycho-
logical well-being, reduce stress, and enhance mindfulness
and flourishing: A randomized controlled occupational
health study. Evid Based Complement Alternat Med 2013;
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.
2013:676953.
35. Soer R, de Jong AB, Hofstra BL, et al. Does mindfulness
improve after heart coherence training in patients with
chronic musculoskeletal pain and healthy subjects? A pilot
study. Glob Adv Health Med 2015;4:50–55.
36. Armstrong L, Rimes K. Mindfulness-based cognitive
therapy for neuroticism (stress vulnerability): A pilot ran-
domized study. Behav Ther 2016;47:287–298.
37. Morone NE, Greco CM, Moore CG, et al. a mind-body
program for older adults with chronic low back pain: A
randomized clinical trial. JAMA Intern Med 2016;176:
329–337.
38. Guardino CM, Dunkel Schetter C, Bower JE, et al. Ran-
domised controlled pilot trial of mindfulness training for
stress reduction during pregnancy. Psychol Health 2014;29:
334–349.
39. Lipschitz DL, Kuhn R, Kinney AY, et al. An exploratory
study of the effects of mind-body interventions targeting
sleep on salivary oxytocin levels in cancer survivors. Integr
Cancer Ther 2015;14:366–380.
40. Mason AE, Epel ES, Kristeller J, et al. Effects of a
mindfulness-based intervention on mindful eating, sweets
consumption, and fasting glucose levels in obese adults:
Data from the SHINE randomized controlled trial. J Behav
Med 2016;39:201–213.
41. Bormann JE, Oman D, Walter KH, et al. Mindful attention
increases and mediates psychological outcomes following
mantram repeition practice in veterans with posttraumatic
stress disorder. Med Care 2014;52:S13–S18.
42. Caldwell K, Harrison M, Adams M, et al. Developing
mindfulness in college students through movement-based
courses: Effects on self-regulatory self-efficacy, mood,
stress, and sleep quality. J Am Coll Health 2010;58:433–442.
43. Lothes J, 2nd, Hakan R, Kassab K. Aikido experience and
its relation to mindfulness: A two-part study. Percept Mot
Skills 2013;116:30–39.
44. Mothes H, Klaperski S, Seelig H, et al. Regular aerobic
exercise increases dispositional mindfulness in men: A
randomized controlled trial. Ment Health Phys Act 2014;7:
111–119.
45. Eliassen BK, Sorlie T, Sexton J, et al. The effect of training
in mindfulness and affect consciousness on the therapeutic
environment for patients with psychoses: An explorative
intervention study. Scand J Caring Sci 2016;30:391–402.
46. Garland SN, Carlson LE, Stephens AJ, et al. Mindfulness-
based stress reduction compared with cognitive behavioral
therapy for the treatment of insomnia comorbid with can-
cer: A randomized, partially blinded, noninferiority trial. J
Clin Oncol 2014;32:449–457.
15
47. Goldin P, Ziv M, Jazaieri H, et al. Randomized controlled
trial of mindfulness-based stress reduction versus aerobic
exercise: Effects on the self-referential brain network in
social anxiety disorder. Front Hum Neurosci 2012;6:295.
48. Kocovski NL, Fleming JE, Hawley LL, et al. Mindfulness
and acceptance-based group therapy versus traditional
cognitive behavioral group therapy for social anxiety dis-
order: A randomized controlled trial. Behav Res Ther 2013;
51:889–898.
49. Mantzios M, Wilson JC. Making concrete construals
mindful: A novel approach for developing mindfulness and
self-compassion to assist weight loss. Psychol Health 2014;
29:422–441.
50. McIndoo CC, File AA, Preddy T, et al. Mindfulness-based
therapy and behavioral activation: A randomized controlled
trial with depressed college students. Behav Res Ther 2016;
77:118–128.
51. Pinniger R, Brown RF, Thorsteinsson EB, et al. Argentine
tango dance compared to mindfulness meditation and a
waiting-list control: A randomised trial for treating de-
pression. Complement Ther Med 2012;20:377–384.
52. Schellekens MPJ, Tamagawa R, Labelle LE, et al.
Mindfulness-based cancer recovery (MBCR) versus sup-
portive expressive group therapy (SET) for distressed
breast cancer survivors: Evaluating mindfulness and social
support as mediators. J Behav Med 2017;40:414–422.
53. Shapiro SL, Oman D, Thoresen CE, et al. Cultivating
mindfulness: Effects on well-being. J Clin Psychol 2008;
64:840–862.
54. Anderson T. Personalizing the Training of Attention: Pre-
dicting Effectiveness of Meditation using Traits and Abilities.
[Masters Thesis] Toronto (Canada): Department of Psychology,
University of Toronto, 2016. https://pdfs.semanticscholar
.org/c8d6/e3cb0e0b267a9e16dbf8633c40cdebb05242.pdf?_
ga=2.112715719.2108367861.1559793110-1882792870
.1559793110
55. Fox KC, Dixon ML, Nijeboer S, et al. Functional neuro-
anatomy of meditation: A review and meta-analysis of 78
functional neuroimaging investigations. Neurosci Biobehav
Rev 2016;65:208–228.
56. Chesak SS, Bhagra A, Schroeder DR, et al. Enhancing
resilience among new nurses: Feasibility and efficacy of a
pilot intervention. Ochsner J 2015;15:38–44.
57. Leong K, Chan P, Grabovac A, et al. Changes in mind-
fulness following repetitive transcranial magnetic sti-
mulation for mood disorders. Can J Psychiatry 2013;58:
687–691.
58. Moore SD, Brody LR, Dierberger AE. Mindfulness and
experiential avoidance as predictors and outcomes of the
narrative emotional disclosure task. J Clin Psychol 2009;
65:971–988,
59. Potash JS, Ho AHY, Chan F, et al. Can art therapy reduce
death anxiety and burnout in end-of-life care workers? A
quasi-experimental study. Int J Palliat Nurs 2014;20:233–
240.
60. Soler J, Elices M, Franquesa A, et al. Exploring the ther-
apeutic potential of ayahuasca: Acute intake increases
mindfulness-related capacities. Psychopharmacology 2016;
233:823–829.
61. Banks JB, Welhaf MS, Srour A. The protective effects of
brief mindfulness meditation training. Conscious Cogn
2015;33:277–285.
62. Bergen-Cico D, Possemato K, Cheon S. Examining the
efficacy of a brief mindfulness-based stress reduction (brief
 16
MBSR) program on psychological health. J Am Coll Health
2013;61:348–360.
63. Bieling PJ, Hawley LL, Bloch RT, et al. Treatment specific
changes in decentering following mindfulness-based cog-
nitive therapy versus antidepressant medication or placebo
for prevention of depressive relapse. J Consult Clin Psychol
2012;80:365–372.
64. Britton WB, Lepp NE, Niles HF, et al. A randomized
controlled pilot trial of classroom-based mindfulness
meditation compared to an active control condition in sixth-
grade children. J Sch Psychol 2014;52:263–278.
65. Chiesa A, Mandelli L, Serretti A. Mindfulness-based cog-
nitive therapy versus psycho-education for patients with
major depression who did not achieve remission following
antidepressant treatment: A preliminary analysis. J Altern
Downloaded by Ucsf Library University of California San Francisco from www.liebertpub.com at 06/28/19. For personal use only.
Complement Med 2012;18:756–760.
66. Chiesa A, Castagner V, Andrisano C, et al. Mindfulness-
based cognitive therapy vs. psycho-education for patients
with major depression who did not achieve remission fol-
lowing antidepressant treatment. Psychiatry Res 2015;226:
474–483.
67. Garland EL, Roberts-Lewis A, Tronnier CD, et al. Mind-
fulness-oriented recovery enhancement versus CBT for co-
occurring substance dependence, traumatic stress, and
psychiatric disorders: Proximal outcomes from a pragmatic
randomized trial. Behav Res Ther 2016;77:7–16.
68. Goldberg SB, Wielgosz J, Dahl C, et al. Does the five facet
mindfulness questionnaire measure what we think it does?
Construct validity evidence from an active controlled ran-
domized clinical trial. Psychol Assess 2016;28:1009–1014.
69. Hou RJ, Wong SYS, Yip BHK et al. The effects of
mindfulness-based stress reduction program on the mental
health of family caregivers: A randomized controlled trial.
Psychother Psychosom 2014;83:45–53.
70. Kingston J, Chadwick P, Meron D, Skinner TC. A pilot
randomized control trial investigating the effect of mind-
fulness practice on pain tolerance, psychological well-
being, and physiological activity. J Psychosom Res 2007;
62:297–300.
71. McClintock AS, Anderson T, Cranston S. Mindfulness
therapy for maladaptive interpersonal dependency: A pre-
liminary randomized controlled trial. Behav Ther 2015;46:
856–868.
72. Noggle JJ, Steiner NJ, Minami T, Khalsa SBS. Benefits of
yoga for psychosocial well-being in a US high school
curriculum: A preliminary randomized controlled trial. J
Dev Behav Pediatr 2012;33:193–201.
73. Robins JL, Elswick RK Jr, Sturgill J, McCain N. The ef-
fects of tai chi on cardiovascular risk in women. Am J
Health Promot 2016;30:613–622.
74. Schmidt S, Grossman P, Schwarzer B, et al. Treating fi-
bromyalgia with mindfulness-based stress reduction: Re-
XIA ET AL.
sults from a 3-armed randomized controlled trial. Pain
2011;152:361–369.
75. Schonert-Reichl KA, Oberle E, Lawlor MS, et al. Enhan-
cing cognitive and social-emotional development through a
simple-to-administer mindfulness-based school program
for elementary school children: A randomized controlled
trial. Dev Psychol 2015;51:52–66.
76. Silverstein RG, Brown ACH, Roth HD, Britton WB. Ef-
fects of mindfulness training on body awareness to sexual
stimuli: Implications for female sexual dysfunction. Psy-
chosom Med 2011;73:817–825.
77. Smith BW, Shelley BM, Dalen J, et al. A pilot study com-
paring the effects of mindfulness-based and cognitive-
behavioral stress reduction. J Altern Complement Med 2008;
14:251–258.
78. Zeidan F, Johnson SK, Diamond BJ, et al. Mindfulness
meditation improves cognition: Evidence of brief mental
training. Conscious Cogn 2010;19:597–605.
79. Ross A, Thomas S. The health benefits of yoga and exer-
cise: A review of comparison studies. J Altern Complement
Med 2010;16:3–12.
80. Burton M, Schmertz SK, Price M, et al. The relation be-
tween mindfulness and fear of negative evaluation over the
course of cognitive behavioral therapy for social anxiety
disorder. J Clin Psychol 2013;69:222–228.
81. Van Dam NT, Sheppard SC, Forsyth JP, et al. Self-
compassion is a better predictor than mindfulness of
symptom severity and quality of life in mixed anxiety and
depression. J Anxiety Disord 2011;25:123–130.
82. Soler J, Cebolla A, Feliu-Soler A, et al. Relationship between
meditative practice and self-reported mindfulness: The
MINDSENS composite index. PLoS One 2014;9:e86622.
83. Lutz A, Jha AP, Dunne JD, et al. Investigating the phenom-
enological matrix of mindfulness-related practices from a
neurocognitive perspective. Am Psychol 2015;70:632–658.
84. Levinson DB, Stoll EL, Kindy SD, et al. A mind you can
count on: Validating breath counting as a behavioral mea-
sure of mindfulness. Front Psychol 2014;5:1202.
85. Ahani A, Wahbeh H, Nezamfar H, et al. Quantitative
change of EEG and respiration signals during mindfulness
meditation. J Neuroeng Rehabil 2014;11:87.
Address correspondence to:
Tom Xia, MD
Department of Psychiatry and Behavioral Sciences
Keck School of Medicine of USC
1200 N, State Street CT-A7D
Los Angeles, CA 90033
E-mail: Tom.Xia@med.usc.edu