Exploring the applications of second-generation mindfulness-based interventions for improving health and human functioning : a mixed-methods investigation

• Main Author: Van Gordon, W.
• Published: Nottingham Trent University 2017
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.734403

Scientific and public interest into the health applications of mindfulness has increased substantially in recent decades. However, the rapidity at which mindfulness has been assimilated by Western research and applied settings has prompted concerns as to whether mindfulness-based interventions (MBIs) frame mindfulness in a manner that (i) resembles the traditional Buddhist conceptualisation of the technique, and (ii) is optimal in terms of treatment effectiveness. To address these concerns, there has recently been a growth of empirical investigation into what have been termed second-generation mindfulness-based interventions (SG-MBIs). SG-MBIs are distinct from first-generation mindfulness-based interventions (FG-MBIs) because in addition to being overtly spiritual or psycho-spiritual in nature, they typically employ (i) a greater range of (normally secularised) meditative techniques, (ii) ethics as a key component of the taught program, and (iii) an instructor training program that normally requires several years of supervised mindfulness practice. The purpose of this doctoral thesis is to advance scientific understanding regarding the health-related applications, mechanisms of action, and limitations of SG-MBIs. Section A of the thesis (Chapters 2 to 7) provides the theoretical foundations to support the operationalisation of SG-MBIs in clinical and other applied settings. In addition to reviewing and critically appraising the relevant literature as well as outlining the conceptual underpinnings of SG-MBIs (Chapters 2-4), Section A introduces several alternative models of mental illness that integrate Buddhism's emphasis on attachment to ego as a key determinant of suffering (Chapters 5 and 6). These models explicate the principles underlying the use of SG-MBIs for improving health and human functioning. In addition to direct treatment applications, an additional focus of the thesis is to explore the effectiveness of SG-MBIs for improving civic engagement and citizenship more generally. Consequently, Chapter 7 focusses on the integration of SG-MBIs into the work setting and delineates the challenges associated with employing mindfulness for improving work-related wellbeing and work effectiveness. The theses continues with Section B (Chapters 8 to 11) that employs quantitative and qualitative study designs to assess the effectiveness, feasibility, and flexibility of an SG-MBI known as Meditation Awareness Training (MAT) for improving health and wellbeing in different patient groups. Chapter 8 reports findings from an active-controlled RCT that demonstrated MAT is an effective for treating fibromyalgia and for helping individuals with fibromyalgia re-engage with paid and unpaid work. A mediation analysis conducted as part of the same study also demonstrated that undermining attachment to ego asserted a role in symptom reduction. This outcome was supported by Chapter 9 which reports findings from a qualitative investigation that demonstrated that individuals with fibromyalgia experience MAT as an effective means of helping them change their relationship with pain by becoming less self-centred. A clinical case study (Chapter 10) provided an in-depth account of the assessment, case formulation, and treatment phases that were employed as part of the successful treatment of sex-addiction using MAT. A further outcome of this case study was that following completion of the MAT intervention, the study participant demonstrably strengthened their career trajectory. Finally, a non-randomised controlled trial (Chapter 11) demonstrated the feasibility and effectiveness of MAT for treating workaholism. Following the focus in Sections A and B on theory and research, respectively, Section C (Chapter 12) focusses on practice and synthesizes key findings from the aforementioned studies in order to explicate how they can improve the delivery and content of mindfulness-based approaches. In summary, findings indicate that SG-MBIs have treatment applications across a range of pathologies and for improving adaptive psychosocial functioning more generally. The thesis contributes to the growing evidence base supporting the clinical utility of SG-MBIs and suggests that they can complement FG-MBIs by increasing the choice of MBI that are available to prospective mindfulness practitioners.