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Cited by 65Mindfulness and Compassion InterventionsPsychotherapy Techniques and ApplicationsDigital Mental Health Interventions

Dismantling Mindfulness-Based Programs: a Systematic Review to Identify Active Components of Treatment

Open access
Stein, Elena, Witkiewitz, Katie·2020·Mindfulness
DOI 10.1007/s12671-020-01444-0PMC PMC9937445
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Abstract

Objectives Elucidating the active ingredients of psychological treatments is an important step in the scientific validation of these interventions. Component studies are one way to test which aspects of psychological treatments impact outcomes, or in other words, are the active ingredients of treatment. As research and popular interest in mindfulness-based programs grows, it is important to evaluate the active ingredients of these programs and to continually refine theorized models of the mechanisms of mindfulness. Studying active ingredients may help clarify which elements of mindfulness-based programs are most important for dissemination.Methods We conducted a systematic review of component studies of mindfulness-based programs for adults with psychological conditions. PRISMA guidelines for systematic reviews were followed.Results Eight component studies were identified. These studies dismantled mindfulness-based stress reduction, mindfulness-based cognitive therapy, unified mindfulness, and core mindfulness processes. The eight studies differed with respect to types of programs and populations studied, yet similarities emerged. Notably, acceptance coupled with awareness and mindfulness meditation training may be two promising active ingredients of these different programs.Conclusions Future studies examining mindfulness-based programs should continue to attempt to dismantle active ingredients of treatment and use the findings to update theoretical models of mindfulness.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review located eight component studies that took apart mindfulness-based programs to see which elements drive outcomes. Across varied programs and samples, the evidence pointed most consistently to acceptance paired with present-moment awareness, and to meditation training itself, as promising active ingredients.

Key findings

  • Eight studies met criteria, covering MBCT, MBSR, Unified Mindfulness, and shared mindfulness processes; total enrollment was 758 participants, with individual samples ranging from 40 to 274.
  • In MBSR dismantling trials, adding acceptance to monitoring improved positive affect (MA ds = .61–.70 vs. MO ds = .32–.43) and stress outcomes; for momentary stress, MA decreased more than MO (d = .27) and no-treatment (d = .40), while MO did not differ significantly from no-treatment (d = .13).
  • In smartphone Unified Mindfulness trials, MA showed lower peak cortisol than MO (ds = .50–.51) and control (ds = .55–.62), lower systolic blood pressure than MO (d = .41) and control (d = .72), greater positive affect, less loneliness, and more social contact than MO/control.
  • MBCT dismantling was mixed: Williams found no overall relapse-prevention advantage, but the childhood-trauma subgroup had 41% relapse with MBCT vs. 65% with TAU (significant) and 54% with psychoeducation (not significant); Chiesa found full MBCT better for depression and quality of life but with a confounded comparison; Britton found focused attention and open monitoring produced different skill use while both increased non-reactivity and attentional control. Valdez’s laboratory study suggested present-moment contact without nonjudgment may be harmful.

Methods

  • PRISMA-guided systematic review; PROSPERO registration was under review (ID 137165). Searched PubMed and PsycINFO from earliest available to July 2019, plus reference lists, using component/dismantling/additive/mechanism terms combined with mindfulness.
  • Included English peer-reviewed studies of adults over 18 with a psychological condition, testing components of an MBP that included formal mindfulness meditation, with additive or dismantled comparison designs; excluded comparisons of distinct treatments or full program vs. control.
  • Data extracted via PICOS; narrative synthesis because studies were too few and heterogeneous for meta-analysis; risk of bias assessed with NIH quality tools.

Limitations

  • Stated by the authors: included studies often had small, underpowered samples, lacked blinding or adherence checks, and relied on contested self-report mindfulness measures; few tested whether components engaged mechanisms; only a minority included clinical samples, and among those, many participants were women and, when reported, predominantly white; some authors did not reply to missing-detail requests.
  • Stated or evident: Chiesa’s control included extra non-MBCT elements and used last-observation-carried-forward imputation; Williams was not strict intention-to-treat (7% missing all follow-up data); Valdez was a laboratory induction, not a clinical trial; concurrent stress/nonjudgment ratings prevented mediation testing.
  • Evident from the review design: only eight heterogeneous studies were synthesized narratively, so conclusions about active ingredients remain provisional and cannot establish relative effect sizes across programs.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s12671-020-01444-0

Cites

63 of 63 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 81 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    Three studies used a dismantling design to test components of MBCT.

    “Three studies utilized a dismantling design to test components of mindfulness-based cognitive therapy (MBCT; Teasdale et al., 2000).”
    Quote in the paperSubstantial claim
  • Findingcitation

    Williams et al. (2014) enrolled adults with at least three prior depressive episodes but no current episode.

    “The first MBCT dismantling trial by Williams et al. (Williams et al., 2014) enrolled adults with at least three prior depressive episodes, but no current episode, consistent with prior findings that MBCT is particularly effective for preventing recurrence of depression among individuals who have had at least three prior episodes (Piet & Hougaard, 2011).”
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    • cites Williams et al., 2014 source

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  • Findingcitation

    A third MBCT study compared full MBCT to structurally equivalent focused attention and open monitoring groups.

    “A third and more recent study by Britton et al. (2018) was a three-arm dismantling study comparing the full MBCT package to two structurally equivalent groups that isolated distinct hypothesized mechanisms of mindfulness meditation: a focused attention condition and an open monitoring condition.”
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    • cites Britton et al. (2018) source

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  • Findingcitation

    In Chiesa et al., other non-meditation MBCT components were excluded from the psycho-education group.

    “Furthermore, other non-meditation components of MBCT were excluded from the psycho-education group (i.e., pleasant event recording or writing relapse plans).”
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    • cites Chiesa et al., 2015 source

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  • Findingcitation

    Chiesa et al. (2015) recruited adults with Major Depressive Disorder whose symptoms had not remitted after at least eight weeks on antidepressant medication.

    “Similar in study design, Chiesa et al. (2015) also recruited a sample of adults with Major Depressive Disorder whose symptoms had not remitted after at least eight weeks on antidepressant medication.”
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    • cites Chiesa et al., 2015 source

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  • Classified as probably not a substantial claim. 15
  • May combine two claims. 46
  • The quote only partly states this claim. 4

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The included studies delivered MBPs in varied formats: four in weekly group format, four via smartphone application, and one using laboratory-induced components.

    “Four studies delivered the programs in a weekly group format that consisted of instruction in mindfulness practice (or control program), discussion of challenges in practice, and assignment of independent home meditation practice”
    • Also stated in: § Study Selection and Characteristics · plain
      “Four studies were based on a parent study delivering an MBP via smartphone application”
    • Also stated in: § Study Selection and Characteristics · plain
      “Finally, one study examined the effects of laboratory induced MBP components”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Across the eight studies, 758 participants were enrolled.

    “Across these eight studies, a total of 758 participants were enrolled.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The review identified eight component studies of mindfulness-based programs for adults with psychological conditions.

    “Eight component studies were identified.”
    • Also stated in: § Study Selection and Characteristics · plain
      “Thus, eight studies met full eligibility criteria and were included in the qualitative synthesis.”
    Quote in the paperSubstantial claim

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    Findingcitation

    The MBCT dismantling studies reported effects on time to depressive episode, affective symptoms, trait mindfulness, mindfulness skill, attentional control, and general well-being.

    “These studies reported the effects of MBCT components on post-program time to depressive episode, affective symptoms, trait mindfulness, mindfulness skill, attentional control, and general well-being.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    MBP components were tested in varied populations: four studies recruited stressed community adults with a Perceived Stress Scale cutoff of five, three delivered MBCT to adults with clinical or subclinical affective symptoms, and one enrolled women with physical or sexual assault trauma.

    “Four studies recruited stressed adults from the community, as assessed by a cut-off score of five on the Perceived Stress Scale”
    • Also stated in: § Participant Characteristics · plain
      “Three studies delivered MBCT to adults with clinical or subclinical affective symptoms including depression, anxiety, and stress”
    • Also stated in: § Participant Characteristics · plain
      “One study enrolled women who experienced physical or sexual assault trauma”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Individual study sample sizes ranged from 40 to 274.

    “Individual studies had sample sizes ranging from 40 to 274.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    In Williams et al., the sample had no prior regular meditation practice and was not concurrently receiving other therapy.

    “This sample had no prior regular meditation practice and were not concurrently receiving other therapy.”
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    • cites Williams et al., 2014 source

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    Findingnone given

    Among the eight included studies, three dismantled MBCT, two dismantled MBSR, three dismantled Unified Mindfulness, and one evaluated core mindfulness processes.

    “These studies dismantled mindfulness-based stress reduction, mindfulness-based cognitive therapy, unified mindfulness, and core mindfulness processes.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Two MBCT dismantling studies compared full MBCT to a version with mindfulness meditation training removed, testing whether formal meditation training is the active ingredient.

    “Two of these studies dismantled MBCT by comparing the full MBCT package to a version with mindfulness meditation training removed, thus testing the hypothesis that formal meditation training is the active ingredient of this program (Chiesa et al., 2015; Williams et al., 2014).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The eight studies differed in the programs and populations they studied, but similarities emerged across them.

    “The eight studies differed with respect to types of programs and populations studied, yet similarities emerged.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mindfulness-based programs tend to be grounded in the same or similar core elements.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Britton et al. recruited a sample including non-clinical and mild to moderate clinical affective disturbances, including depression, anxiety, and stress.

    “This study recruited a sample that included non-clinical and mild to moderate clinical expressions of affective disturbances, including depression, anxiety, and stress.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Britton et al., 2018 source

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    Findingcitation

    In Williams et al., subgroup analyses showed that those with more childhood trauma had lower depression relapse risk with MBCT (41%) than TAU (65%; significant) or cognitive psycho-education (54%; not significant but perhaps clinically meaningful).

    “However, subgroup analyses revealed that those with more childhood trauma had lower risk of depression relapse if they received MBCT (41% relapsing) compared to TAU (65%; statistically significant) or MBCT compared to cognitive psycho-education (54%; not statistically significant, but perhaps clinically meaningful).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Williams et al., 2014 source

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    Findingcitation

    Both FA and OM groups showed increases in non-reactivity and attentional control, and full MBCT showed significant increases across all mindfulness skill and attention control measures.

    “However, both FA and OM groups showed increases in non-reactivity and attentional control following the program and the full MBCT group also showed significant increases across all mindfulness skill and attention control measures.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Britton et al., 2018 source

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    Findingcitation

    In Chiesa et al., the psycho-education control included additional components not in MBCT, such as stretching or aerobic activity, information on light exposure, diet, relationships, behavior activation, and cognitive reappraisal.

    “the psycho-education control group in this study was described as including additional components not present in MBCT, such as the suggestion for participants to practice stretching or aerobic activity for 30–45 minutes, six days per week, as well as general information about factors to reduce or prevent depressive symptoms such as light exposure, balanced diet, and positive interpersonal”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chiesa et al., 2015 source

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    Findingcitation

    Chiesa et al. found greater improvements from full MBCT than psycho-education, particularly for depression symptoms and quality of life at long-term follow-up.

    “Although this study found greater improvements from full MBCT compared to the psycho-education group, particularly for depression symptoms and quality of life at long term follow-up”
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    • cites Chiesa et al., 2015 source

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    Findingcitation

    Participants in Britton et al. were randomized to MBCT, FA, or OM, and pre-post mindfulness change was assessed by the Five Facet Mindfulness Questionnaire and the Attention Control Questionnaire.

    “Participants were randomized to receive either MBCT, FA, or OM and pre-post change in mindfulness was assessed by the Five Facet Mindfulness Questionnaire and the Attention Control Questionnaire.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Britton et al., 2018 source

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    Findingnone given

    Among studies that recruited clinical samples, a large proportion of participants were women and, when race/ethnicity was reported, predominantly white with either depression or trauma.

    “Among those studies that recruited clinical samples, a large proportion of participants were women and, when race/ethnicity was reported, predominantly white with either depression or trauma.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Risk of bias in included publications was assessed using the National Institute of Health Quality Assessment of Controlled Intervention Studies.

    “Risk of bias in publications was assessed using the National Institute of Health Quality Assessment of Controlled Intervention Studies (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Several included publications reported on the same sample, so that sample was counted only once toward the total number of participants.

    “Of note, several of the included publications reported on the same sample of participants (Chin, Lindsay, Greco, Brown, Smyth, Wright, et al., 2019; Lindsay, Chin, et al., 2018; Lindsay et al., 2019; Lindsay, Young, et al., 2018), so this sample was only counted once toward the total number of participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All eligible studies were included in the narrative synthesis regardless of risk of bias, but were interpreted in the context of possible bias.

    “All studies meeting inclusion criteria were included in the narrative synthesis of findings even if they demonstrated risk of bias, but they were interpreted in the context of possible bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The review protocol was submitted for preregistration with PROSPERO in May 2019 and remained under review.

    “The methodology of this systematic review was submitted for pre-registration with PROSPERO, International prospective register of systematic reviews, in May 2019, and currently remains under review (ID 137165).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Acceptance combined with awareness and mindfulness meditation training may be two promising active ingredients across these different programs.

    “Notably, acceptance coupled with awareness and mindfulness meditation training may be two promising active ingredients of these different programs.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mindfulness-based programs tend to be grounded in the same or similar core elements.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    PRISMA guidelines for systematic reviews were followed.

    “PRISMA guidelines for systematic reviews were followed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    All participants increased in reports of nonjudgement (MA d .88; MO d .73; NT d .31); MA increased nonjudgement significantly more than MO (d .16) and NT (d .56); MO increased compared to NT (d .39).

    “all participants increased in their reports of nonjudgement (MA: d= .88; MO: d= .73; NT: d= .31), and MA increased nonjudgement significantly more than MO (d= .16) and NT (d= .56). Additionally, MO increased in nonjudgment compared to NT (d= .39).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chin et al. (2019) source

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    Premisecitation

    MA had lower systolic blood pressure during the mTSST than MO (d .41) and control (d .72); this effect was not observed for diastolic blood pressure.

    “the MA had lower systolic blood pressure during the mTSST than the MO group (d= .41) and control group (d= .72). This effect was not observed for diastolic blood pressure during the task.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay, Young, et al., 2018 source

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    Premisecitation

    All groups reported a decrease in number of daily stress occasions (MA d .73; MO d .36; NT d .16); the change was significantly greater for MA than MO (d .38) and NT (d .62), with no significant difference between MO and NT (d .22).

    “all groups reported a decrease from pre- to post-program (MA: d = .73; MO: d = .36; NT: d = .16), and this change was significantly greater for MA compared to both MO (d= .38) and NT (d= .62). No significant difference in magnitude of change was found between MO and NT (d= .22).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chin et al. (2019) source

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    Interpretationreasoning

    These MBSR studies shed light on effects of different psychological processes within MBSR.

    “These studies shed light on the effects of different psychological processes found within MBSR.”
    Quote in the paperSubstantial claim

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    Interpretationcitation

    Acceptance skills training is an active ingredient of MBSR impacting primarily positive affect, with a weaker effect on negative affect.

    “Thus, this study provided evidence that acceptance skills training is an active ingredient of MBSR impacting primarily positive affect, with a weaker effect on negative affect.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chin, Lindsay, and colleagues (2019; 2018)

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    Interpretationcitation

    Britton et al. provides evidence that dismantled MBCT components engage different aspects of mindfulness, but it remains unclear if or how clinical outcomes are impacted by different mindfulness skill engagement.

    “Although this component study contributes important evidence that dismantled components of MBCT successfully engage different aspects of mindfulness, it remains unclear from this particular study if or how clinical outcomes are impacted by different mindfulness skill engagement.”
    Quote in the paperSubstantial claim

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    Study design and conductcitation

    Chiesa et al. presents somewhat low risk of bias, but missing data imputed using last observation carried forward may introduce bias.

    “Overall this study presents somewhat low risk of bias (see Table 2), but missing data was imputed using the last observation carried forward method, which may introduce bias (Hallgren & Witkiewitz, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hallgren & Witkiewitz, 2013 source

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    Premisecitation

    MA had significantly lower peak cortisol after the mTSST than MO (ds .50-.51) and control (ds .55-.62), with no significant difference between MO and control.

    “those in the MA group had significantly lower peak cortisol levels after the mTSST task than the MO group (ds= .50 - .51) and control group (ds= .55 - .62), and there was no significant difference in peak cortisol level between the MO group and control group.”
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    • cites Lindsay, Young, et al., 2018 source

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    Interpretationcitation

    A 14-day smartphone program impacts cardiovascular stress reactivity during a social-evaluative stress induction, and training acceptance of experiences is a critical component driving these outcomes.

    “This study provides important evidence that a 14-day smartphone program impacts cardiovascular stress reactivity during a social-evaluative stress induction, and that training acceptance of experiences is a critical component driving these outcomes.”
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    • cites Lindsay, Young, et al., 2018 source

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    Premisecitation

    In Valdez et al.'s laboratory study, for control condition participants, post-interview PMC was negatively associated with positive affect, positively associated with negative affect, and unrelated to trauma intrusions.

    “for those in the control condition, post-interview PMC was negatively associated with positive affect, positively associated with negative affect, and unrelated to trauma intrusions.”
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    • cites Valdez et al. (2016) source

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    Premisecitation

    MA showed a significantly greater decrease in momentary stress ratings than MO (d .27) and NT (d .40), and MO and NT did not differ significantly (d .13).

    “the MA group showed a significantly greater decrease in momentary stress ratings compared to MO (d= .27) and to NT (d= .40) and there was no significant difference in stress reduction between MO and NT (d= .13).”
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    Premisecitation

    In the nonjudgment induction condition, post-interview PMC was unrelated to positive or negative affect but negatively correlated with trauma intrusions.

    “For those in the nonjudgment induction condition, post-interview PMC was unrelated to either positive or negative affect, but was negatively correlated to trauma intrusions.”
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    Premisecitation

    Participants in both MA and MO significantly increased daily diary positive affect ratings (MA ds .52-.70; MO ds .25-.35) and momentary positive affect ratings (MA d .39; MO d .15) from pre- to post-program.

    “participants in both the MA and MO conditions significantly increased daily diary positive affect ratings (overall positive affect, happiness, calm, vigor; MA: ds= .52 - .70; MO: ds= .25 - .35) and momentary positive affect ratings (MA: d= .39; MO: d= .15) from pre- to post-program.”
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    • cites Lindsay, Chin, et al., 2018 source

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    Premisecitation

    Both MA and MO increased positive affect more than the NT control.

    “Both MA and MO increased positive affect to a greater extent than the NT control group.”
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    • cites Chin, Lindsay, and colleagues (2019; 2018)

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    Premisecitation

    MA and MO showed equivalent decreases in daily diary negative affect; MA's decrease was significantly greater than NT, while MO's decrease was not significantly different from NT.

    “MA and MO showed equivalent decreases in daily diary reports of negative affect, although MA’s decrease was significantly greater than NT, while MO’s decrease was not significantly different from NT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chin, Lindsay, and colleagues (2019; 2018)

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    Premisecitation

    The MA group increased more than MO on daily diary positive affect ratings (gs .46-.54) and momentary positive affect ratings (g .41).

    “Compared to the MO group, the MA group increased to a greater extent on daily diary positive affect ratings (overall positive affect, happiness; gs= .46 - .54) and momentary positive affect ratings (g= .41).”
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    • cites Lindsay, Chin, et al., 2018 source

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    Premisecitation

    In a three-arm dismantling RCT of 137 stressed community adults, both MA and MO increased positive affect from pre- to post-program, with a larger increase for MA (ds .61-.70) than MO (ds .32-.43).

    “both MA and MO significantly increased positive affect from pre- to post-program, but the magnitude of this change was larger for MA (ds= .61-.70) compared to MO (ds= .32-.43).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chin, Lindsay, and colleagues (2019; 2018)

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    Premisecitation

    There is a lack of consensus about the definition of mindfulness, its bounds, and how it is assessed.

    “the lack of consensus about the definition of mindfulness, its bounds, and most relevant for this systematic review, how it is assessed (Van Dam et al., 2018).”
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    • cites Van Dam et al., 2018 source

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    Premisecitation

    MA reported a significant increase in social interaction partners from pre- to post-program (d .39), while MO and control did not change.

    “the MA group reported a significant increase in social interaction partners from pre- to post-program (d= .39) and the MO and control groups did not change.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay et al., 2019 source

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  • Classified as probably not a substantial claim.

    Interpretationnone given

    Component studies of MBPs, including dismantling, additive, and direct component comparisons, have the ability to provide evidence for which elements of treatment drive outcomes.

    “Component studies of MBPs, including dismantling, additive, and direct component comparisons, have the ability to provide evidence for which elements of treatment drive outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Without acceptance skills training, present moment monitoring has a mild effect, but acceptance skills training is the active ingredient for improving positive affect.

    “Together, these results suggest that without acceptance skills training, present moment monitoring has a mild effect, but acceptance skills training is the active ingredient for improving positive affect.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay, Chin, et al., 2018 source

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  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationcitation

    There may be different forms of acceptance: one resembling reappraisal, and another involving intensive objective open monitoring of experience such that equanimity arises naturally.

    “there may be different forms of acceptance, one that more closely resembles reappraisal (e.g., deliberately changing one’s response to a difficult experience towards a more accepting stance), and another that involves such intensive and objective open monitoring of experience that there is no room left for reactivity and thus equanimity arises naturally.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Britton et al.

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    Premisecitation

    MA showed more substantial reductions in loneliness than MO (d .46) and control (d .45), and MO and control did not differ significantly.

    “The MA group showed more substantial reductions in loneliness when compared to the MO group (d= .46) and the control group (d= .45), and the MO and control groups were not significantly different from one another.”
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    • cites Lindsay et al., 2019 source

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    Premisecitation

    MA reported a significant increase in number of daily social interactions from pre- to post-program (d .31-.47), while MO and control did not change.

    “those in the MA group reported a significant increase in the number of daily social interactions from pre- to post-program (d= .31 - .47), while the MO and control groups did not change.”
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    • cites Lindsay et al., 2019 source

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    Premisecitation

    The MA group significantly decreased daily diary subjective loneliness from pre- to post-program (d .44), while MO and control showed no change.

    “the MA group significantly decreased daily diary ratings of subjective loneliness from pre- to post-program (d= .44), while the MO and control groups showed no change in loneliness over time.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay et al., 2019 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Mindfulness may buffer the effects of discrimination stress on depression.

    “mindfulness may buffer the effects of discrimination stress on depression (Shallcross & Spruill, 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shallcross & Spruill, 2018 source

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    Interpretationcitation

    In a series of high-quality studies comparing present moment monitoring alone to monitoring plus acceptance, participants randomized to the acceptance condition had significantly improved outcomes in positive affect, negative affect, daily stress, social interactions, and physiological stress reactivity compared to monitoring-only and control conditions.

    “researchers show that those randomized to the condition including acceptance had significantly improved outcomes in terms of positive affect, negative affect, daily stress, social interactions, and physiological stress reactivity compared to the monitoring only and control conditions”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Chin, Lindsay, Greco, Brown, Smyth, Aidan, et al., 2019 source

      Not checked in the free run.

    • cites Lindsay, Chin, et al., 2018 source

      Not checked in the free run.

    • cites Lindsay, Young, et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The increase in daily social contacts was significantly greater for MA than MO (d .34-.35) and control (d .29-.52).

    “The increase in number of daily social contacts was significantly greater for the MA group as compared to the MO group (d= .34 - .35) and control (d= .29 - .52) group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay et al., 2019 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two studies dismantling MBCT by comparing full treatment to a condition with meditation features removed found advantages for full MBCT in reductions in depression symptoms, increased quality of life, and lower risk of relapse for the subgroup with greater childhood trauma.

    “These studies found advantages for the full MBCT condition in terms of reductions in depression symptoms, increased quality of life, and lower risk of relapse to depressive episodes for the subgroup that also had greater childhood trauma, all indicating that meditation is an active component.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Chiesa et al., 2015 source

      Not checked in the free run.

    • cites Williams et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    There was a main effect of time on daily and momentary negative affect ratings, with participants on average reporting less negative affect from pre- to post-program, but no effect of group.

    “there was a main effect of time on daily and momentary negative affect ratings such that participants on average reported less negative affect from pre- to post-program, but there was no effect of group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay, Chin, et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Lindsay et al. found that the acceptance component of their MBP reduced cardiovascular but not self-reported stress.

    “they found that the acceptance component of their MBP reduced cardiovascular but not self-reported stress.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay, Young, et al., 2018 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    Among existing component studies of MBPs, several have methodological limitations suggesting risk of bias, including small sample sizes that are statistically underpowered and a lack of blinding or protocol adherence measures.

    “several have methodological limitations that suggest risk of bias including small sample sizes that statistically underpowered and a lack of blinding or protocol adherence measures.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These findings are consistent with the Monitor and Acceptance Theory, which proposes that the combination of monitoring and acceptance encourages nonreactivity and improved emotion regulation.

    “these findings were consistent with a proposed mechanistic model explaining how mindfulness impacts health outcomes, that it is the combination of monitoring and acceptance that encourages nonreactivity and improved emotion regulation (Monitor and Acceptance Theory; Lindsay & Creswell, 2017).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Lindsay & Creswell, 2017 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    MBPs may impact the validity and reliability of self-report measures of psychological constructs.

    “it may also be the case that MBPs impact the validity and reliability of self-report measures of psychological constructs.”
    Quote in the paperSubstantial claim
57 of 57

  • The paper relies on this without support.

    Mindfulness-based programs tend to be grounded in the same or similar core elements.

    “A variety of MBPs have been developed to address a range of psychological conditions in diverse populations, and yet these programs tend to be grounded in the same (or similar) core elements.”

  • The paper relies on this without support.

    The core elements of mindfulness-based programs can be conceptualized as shared practices or shared underlying processes.

    “The core elements of MBPs have been conceptualized variously as shared practices (e.g., body scan meditation) or shared underlying processes (e.g., attentional control).”

  • The paper relies on this without support.

    The component manipulations in the included studies validly isolated the targeted active components from other treatment elements.

    “The standard eight-week MBSR group program was characterized as Monitor + Accept (MA), while the comparator group was Monitor Only (MO), which retained the structure of MBSR while removing all language and training alluding to acceptance, nonjudgement, or noninterference.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Research on the mechanisms of mindfulness has predominantly focused on manualized group settings.

    “research on the mechanisms of mindfulness has predominantly focused on manualized group settings [12, 20, 21].”

    From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [20]

    The Results (Study Selection and Characteristics; page unavailable) identify weekly group programs among the studies of mindfulness-program components, and the paper discusses established treatment protocols. But the review also reports smartphone-delivered and laboratory studies; it does not establish that research on mindfulness mechanisms has predominantly focused on manualized group settings. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • These common factors might be unspecific, such as social support, group dynamics, or attention from the intervention teachers.

    “These factors might be unspecific, such as social support, group dynamics, or attention from the intervention teachers [41,73].”

    From Embodied Cognition in Meditation, Yoga, and Ethics—An Experimental Single-Case Study on the Differential Effects of Four Mind–Body Treatments (2022) · cites this paper as [73]

    The Discussion (page not provided) describes a group facilitator’s modeling of nonjudgment as a possible common factor, and the introductory discussion of treatment factors gives working alliance as another example. These passages support the general idea of nonspecific interpersonal factors, but do not identify social support, group dynamics, or attention from teachers as the examples claimed. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • The precise mechanisms through which mindfulness influences depression and anxiety symptoms remain poorly understood.

    “the precise mechanisms through which mindfulness influences depression and anxiety symptoms remain elusive [19–21].”

    From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [20]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Discussion claims a negative-affect advantage that the results do not show

    Minor

    The discussion says the acceptance condition significantly improved negative affect relative to the other conditions. The results instead report no group effect on daily or momentary negative affect.

  • The same cited study is assigned two delivery formats

    Minor

    Lindsay, Chin, et al. (2018) appears in both the weekly-group and smartphone-program lists, although these passages describe the studies as having different delivery formats.

  • Included laboratory study conflicts with the meditation-practice criterion

    Minor

    Eligibility required a studied component to be a formal mindfulness meditation practice, but the review says the included Valdez study did not involve actual meditation practice.

3 of 3

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Related

Authors
Stein, E., & Witkiewitz, K.
Affiliations
University of New Mexico (US)
Corresponding author
Stein, Elena
ORCID
Venue
Mindfulness
Publisher
Springer Science and Business Media LLC
Published
2020-07-25
Volume
11
Issue
11
Pages
2470-2485
ISSN
  • 1868-8527 (ISSN-L)
  • 1868-8535
DOI
10.1007/s12671-020-01444-0
PMC
PMC9937445
OpenAlex
W3044188110
Cited by
63
References
63
Citations by year
2026: 5 · 2025: 15 · 2024: 12 · 2023: 11 · 2022: 11 · 2021: 8 · 2020: 1
FWCI
0.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Mindfulness (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism (T32 AA018108-10, R01 AA025539)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
mindfulness program, mindfulness-based stress reduction, mindfulness-based cognitive therapy, acceptance, awareness, mechanisms of mindfulness

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

Statistics and arithmetic are recomputed, not judged.

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