Standardized applications of MMBI

The mindfulness-based interventions that have received the most attention in clinical applications are all multi-component interventions. MBSR includes instruction in sitting mindfulness meditation, body scan meditation, hatha yoga, and mindfulness in daily life, though the cultivation of present moment awareness is considered to be the common factor of all these activities. The program is a group-based eight-week intervention that includes discussion about how to apply the practice in daily life and involves recommended homework of formal sitting mindfulness meditation and mindfulness in daily life (Kabat- Zinn 2005). MBSR, unlike many of the MMBIs that were derived from it, doesn’t include conventional psychotherapy. MBCT is a group-based eight- week program that integrates elements of MBSR with psychoeducation and cognitive-behavioral strategies for depression (Segal et al. 2002). Mindfulness- based relapse prevention (MBRP) integrates the components of MBSR with relapse prevention, based in CBT, for substance dependence treatment (Bowen et al. 2011).

Other psychotherapies have incorporated mindfulness without including formal practice of sitting meditation. Acceptance and commitment therapy (ACT) integrates mindfulness with concepts of valued living, willingness, and the distinction between self-as-context versus self-as-content (Hayes and Stro- sahl 2010). Dialectical behavior therapy (DBT), also considered a mindfulness- based approach, involves mindfulness exercises to promote self-monitoring as part of emotional regulation skills training in the treatment of borderline personality and other disorders (Linehan 1993).

The classification of MMBI according to the religious origins of the practice has led some forms of meditation, such as kindness-based meditation (KBM), to be regarded as mindfulness because they have historically been practiced alongside mindfulness meditation in Buddhist tradition. A recent review indicated that KBM includes several related types of meditation, such as lovingkindness and compassion meditation, that focus on generating feelings of loving-kindness or compassion toward others (Galante et al. 2014). KBM differs from mindfulness approaches because the aim of the meditation is not to just observe experience but to create a different type of experience involving loving and compassionate feelings toward others.

As mentioned earlier, MMBIs that involve mantra repetition have been long regarded as “non-mindfulness” types. TM, the best-researched among them, uses the silent repetition of a mantra or sound to produce transcendental consciousness, or heightened awareness of self and the world; mindfulness is presumed to be a by-product of that heightened awareness (Tanner et al. 2009). Implementations of TM in clinical studies have used a combination of individual and group-based formats and the intervention does not include elements of hatha yoga or conventional psychotherapy (Orme-Johnson and Barnes 2014).

Inner resources for stress (IR) is a group-based eight-week intervention that uses mindfulness meditation, breath-focused imagery and mantra repetition, and mindfulness in daily life with practices for letting go of thoughts, feelings, and sensations as they arise. In IR, breath-focused mantra and imagery, as more structured forms of FA than simple breath awareness, are used to provide helpful structure for practitioners who otherwise would not be able to tolerate mindfulness practice because of intrusive thoughts and feelings (Butler et al. 2008; Waelde et al. 2004, 2008).

The mantram repetition program (MRP), which has been used for military veteran PTSD and other conditions, is a group-based meditation intervention that uses a client-selected sacred word, repeated silently throughout the day, as a method to train attention and regulate emotion. In MRP, mantram is deliberately spiritual, to call on spiritual resources, and does not rely on sitting meditation, to increase the portability of the practice. Mantram helps to manage unwanted thoughts by directing “attention away from negative thoughts in advance, thereby reducing emotional distress” (Bormann et al. 2013, p. 260).

With the exception of MRP, these standardized MMBIs all incorporate mindfulness in some way, though MRP includes the FA form of mindfulness practice, and mindfulness in TM practice is thought to be a result of the NDA achieved by the practice. Mindfulness itself, like the MMBI in which it is incorporated, may contain multiple components that produce distinct treatment mechanisms.

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