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The validation of an active control intervention for Mindfulness Based Stress Reduction (MBSR)
Open accessAbstract
Most of the extant literature investigating the health effects of mindfulness interventions relies on wait-list control comparisons. The current article specifies and validates an active control condition, the Health Enhancement Program (HEP), thus providing the foundation necessary for rigorous investigations of the relative efficacy of Mindfulness Based Stress Reduction (MBSR) and for testing mindfulness as an active ingredient. 63 participants were randomized to either MBSR (n = 31) or HEP (n = 32). Compared to HEP, MBSR led to reductions in thermal pain ratings in the mindfulness- but not the HEP-related instruction condition (η(2) = .18). There were significant improvements over time for general distress (η(2) = .09), anxiety (η(2) = .08), hostility (η(2) = .07), and medical symptoms (η(2) = .14), but no effects of intervention. Practice was not related to change. HEP is an active control condition for MBSR while remaining inert to mindfulness. These claims are supported by results from a pain task. Participant-reported outcomes (PROs) replicate previous improvements to well-being in MBSR, but indicate that MBSR is no more effective than a rigorous active control in improving these indices. These results emphasize the importance of using an active control condition like HEP in studies evaluating the effectiveness of MBSR.
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“consequently, for the past 10 years, more and more meditation studies have used longitudinal Rct design with active controls such as relaxation training, health education or enhancement programs, physical exercise, and cognitive tasks (Davidson, 2010;Maccoon et al., 2012;2014;Rosenkranz et al., 2013;terburg et al., 2009).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Maccoon et al., 2012
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“however, later rigorous Rct studies using an active control failed to replicate these results.”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Maccoon et al., 2012
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Other longitudinal Rcts also showed no sustained attention differences between MBsR and heP, MBsR and heP had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms (Davidson, 2010;Maccoon et al., 2012;2014;Rosenkranz et al., 2013).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Maccoon et al., 2012
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“the waitlist control has been intensively investigated in the meditation field (Davidson, 2010;Maccoon, Maclean, Davidson, saron, & lutz, 2014;Maccoon et al., 2012;Rosenkranz et al., 2013;terburg et al., 2009).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Maccoon et al., 2012
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“For example, a series of studies used MBsR vs. health enhancement Program (heP) to validate the active control in meditation (Davidson, 2010;Maccoon et al., 2012;2014;Rosenkranz et al., 2013).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Maccoon et al., 2012
In the citing paper
“Yet, non-specific factors are often viewed primarily as a confound in studies of MBI mechanisms (but see33–35) and used as motivation for increasing the rigor of comparison conditions to isolate the specific effects of MBIs28,36–38.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [38]
In the citing paper
“Although the HEP and mindfulness conditions were effective at improving mood, stress, and cognition, they did not significantly differ.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [74]
In the citing paper
“However, the mindfulness program was more effective at reducing inflammatory markers in response to a social stress test95 and pain.74”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [74]
In the citing paper
“However, the MBSR program was more effective at reducing inflammatory responses following social stress141 and experimentally-induced pain ratings.139”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [139]
In the citing paper
“Although the HEP and MBSR program were effective at reducing self-reports of anxiety, distress, hostility,139 and attentional stability,140 there were no significant differences between groups.”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [139]
In the citing paper
“a validated, active control condition (the health enhancement program; HEP) that was matched for intervention effects non-specific to mindfulness meditation (MacCoon et al., 2012).”
From Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli (2018) · cites this paper as MacCoon et al., 2012
In the citing paper
“The intervention and randomization procedures were identical to that detailed by MacCoon et al. (2012)”
From Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli (2018) · cites this paper as MacCoon et al., 2012
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Metadata
- Authors
- MacCoon, D. G., Imel, Z. E., Rosenkranz, M. A., Sheftel, J. G., Weng, H. Y., Sullivan, J. C., Bonus, K. A., Stoney, C. M., Salomons, T. V., Davidson, R. J., & Lutz, A.
- Affiliations
- University of Wisconsin–Madison (US)
- University of Washington (US)
- University of Wisconsin Health (US)
- National Institutes of Health (US)
- Corresponding author
- MacCoon, Donal G.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2012-01
- Volume
- 50
- Issue
- 1
- Pages
- 3-12
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC3257026
- OpenAlex
- W2145128570
- Cited by
- 335
- References
- 61
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 12 · 2023: 22 · 2022: 41 · 2021: 34 · 2020: 34 · 2019: 27 · 2018: 17 · 2017: 18 · 2016: 21 · 2015: 34 · 2014: 19 · 2013: 17 · 2012: 10
- FWCI
- 15.89
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Center for Complementary and Alternative Medicine (U01AT002114-01A1)
- National Institute of Mental Health (P50-MH069315-03)
- Fetzer Institute, and gifts
- John W. Kluge Foundation and the Impact Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- mindfulness-based stress reduction, active control, mindfulness-based interventions, waitlist control, thermal pain, anxiety, hostility, general distress, clinical symptoms, well-being, intervention efficacy
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Pain Measurement, Stress, Psychological, Treatment Outcome, Meditation
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