Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT

“…and distracted behavior being an openness to engaging with one’s experiences), and also measures attention monitoring (on one’s actions or not) (see Brown & Ryan, 2003 for a discussion of the Mindful Attention and Awareness Scale (MAAS) development, on which Act with Awareness is primarily…”

“…and measures: (1) the use of attention to monitor one’s present moment experiences, and (2) a mental attitude of acceptance toward momentary experience (for reviews of the conceptualizations of mindfulness, see Bishop et al., 2004; Quaglia, Brown, Lindsay, Creswell, & Goodman, 2014).”

“Acting early in the stage of attentional deployment (Gross, 2015), acceptance allows a person to orient toward arising affective experiences, monitor them as they occur, and let them pass.”

“…other multi-dimensional models of mindfulness training (which are important to rigorously evaluate; e.g., self-management, dereification, intention; Baer, 2003; Lutz, Jha, Dunne, & Saron, 2015; Shapiro et al., 2006), the basic components of attention monitoring and acceptance are common factors…”

“Perhaps most familiar to psychological and behavioral medicine scientists is the MindfulnessBased Stress Reduction (MBSR) program, an 8-week group-based training program that fosters mindfulness through a series of guided mindfulness meditation practices (Kabat-Zinn, 1982).”

“And though additional active features are identified in other multi-dimensional models of mindfulness training (which are important to rigorously evaluate; e.g., self-management, dereification, intention; Baer, 2003; Lutz, Jha, Dunne, & Saron, 2015; Shapiro et al., 2006), the basic components of attention monitoring a…”

“, attention, working memory, emotion regulation; for reviews, see Chiesa, Calati, & Serretti, 2011; Keng, Smoski, & Robins, 2011; Tang, Hölzel, & Posner, 2015), stress reduction (Creswell & Lindsay, 2014), as well as manymental and physical health outcomes (e.g., delaying HIV progression, reducing risk for drug abuse…”

“Now, a new wave of interest seeks to characterize the underlying processes involved in trait mindfulness and mindfulness meditation practices (e.g., Hölzel et al., 2011; Lutz, Jha, Dunne, & Saron, 2015; Vago & Silbersweig, 2012).”

“Indeed, the FFMQ Observe subscale is consistently unrelated to or negatively correlated with other mindfulness subscales among non-meditators, but positively correlated among meditators (e.g., Baer et al., 2008; Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006).”

“Mindfulness is commonly defined as a way of paying attention to present-moment experience with amental stance of receptivity and acceptance (Kabat-Zinn, 1994).”

“…may activate frontal and parietal brain regions (e.g., frontal eye field, dorsolateral PFC, inferior and superior parietal lobules) supporting attention orienting, as well as the executive network (e.g., ACC, anterior insula, basal ganglia) that supports conflict monitoring (Tang et al., 2015).”

“…outcomes (e.g., delaying HIV progression, reducing risk for drug abuse and depression relapse, reducing PTSD symptomatology; Creswell, Myers, Cole, & Irwin, 2009; Bowen et al., 2014; Teasdale et al., 2000; Polusny et al., 2015; for reviews, see Khoury et al., 2013; Ludwig & Kabat-Zinn, 2008).”

“, & Creswell, J. D. (2015). Back to the Basics: How Attention Monitoring and Acceptance Stimulate Positive Growth.”

“With long-term practice, though, as acceptance becomes a more automatic response and less effortful regulation of emotion is necessary, the neural correlates of acceptance may change, involving changes in resting state functional connectivity (cf. Brewer et al., 2011; Desbordes et al., 2015).”

“…interventions (e.g., emotion regulation, attention control, and selfawareness; Hölzel et al., 2011; Shapiro, Carlson, Astin, & Freedman, 2006; Vago & Silbersweig, 2012; Tang et al., 2015) by specifying the underlying components of mindfulness that interact to change these downstream…”

“Over the course of mindfulness training, sustained attention also improves as the ability to maintain contact with present-moment experience develops (Chiesa et al., 2011).”

“…Stroop performance, monitoring was unrelated to performance in two studies (instead, acceptance predicted performance; Anicha et al., 2012; Teper & Inzlicht, 2013), and predicted fewer errors but not faster reaction time in another study (while acceptance predicted both; Moore & Malinowski, 2009).”

“Common reactions to negative thoughts and feelings are to avoid them or try to change them (which is often unsuccessful; Wenzlaff & Wegner, 2000), or to become hyperfocused on negative symptoms while ignoring the rest of experience (e.g., Farb et al., 2010; Mathews & MacLeod, 1994).”

“Describe is not central to the construct of mindfulness (cf. Cardaciotto et al., 2008), as it involves additional cognitive processing and elaboration beyond monitoring one’s experiences; while Describe can foster attention monitoring by keeping one anchored in describing present moment…”

“…for these factors or lack these intervention elements (e.g., group support) have been linked with affective and physical health outcomes (e.g., Kabat-Zinn et al., 1998; Polusny et al., 2015; Rosenkranz et al., 2013; Taren et al., 2015), suggesting a mindfulness-specific impact on a broad…”

“…and acceptance in fostering psychological well-being: acceptance appears to be essential for reducing symptoms (and the grasping of positive experiences), while noticing experiences is crucial for appreciating them and building positive states (Garland et al., 2015; Lindsay & Creswell, 2015).”

“, attention, working memory, emotion regulation; for reviews, see Chiesa, Calati, & Serretti, 2011; Keng, Smoski, & Robins, 2011; Tang, Hölzel, & Posner, 2015), stress reduction (Creswell & Lindsay, 2014), as well as manymental and physical health outcomes (e.g., delaying HIV progression, reducing risk for drug abuse…”

“And, as mentioned previously, other mechanistic models of mindfulness training describe additional underlying processes that may be equally important in fostering mindfulness and influencing its associated outcomes (e.g., Lutz et al., 2015).”

“In the health psychology literature, an accepting mindset has been effective for adjusting to chronic pain (McCracken, 1998)2.”

“Despite parallels between monitoring and acceptance components as trained in mindfulness interventions and as measured in multi-faceted selfreport mindfulness scales, there is ongoing debate about the validity of self-report mindfulness measures in relation to mindfulness meditation training (Brown, Ryan, Loverich, Bi…”

“Bodhi, B. (2011). What does mindfulness really mean? A canonical perspective. Contemporary Buddhism, 12(1), 19–39. Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., ... Larimer, M. E. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatm…”

“Acceptance Acceptance is broadly defined as a mental attitude of nonjudgment, openness and receptivity, and equanimity toward internal and external experiences (cf. Baer, Smith, & Allen, 2004; Brown & Ryan, 2004; Desbordes et al., 2015).”

“Specifically, conflict monitoring skills are important for recognizing when the mind wanders from its intended focus (e.g., breath), and orienting skills are necessary to redirect attention back to this focus object (cf. Malinowski, 2013).”

“…1-2 weeks of mindfulness training and practice to foster increases in acceptance (as measured by the FFMQ Nonjudgment and Nonreactivity subscales; Baer et al., 2012), and another study suggests that only those already familiar with acceptance strategies are able to effectively utilize very brief…”

“By reducing distress and stress reactivity, MAT predicts that monitoring and acceptance together explain how mindfulness interventions may improve stress-related health outcomes (Creswell & Lindsay, 2014; Grossman, Niemann, Schmidt, & Walach, 2004).”

“In distressing contexts, monitoring momentary experiences in the absence of acceptance encourages a narrow focus on negative stimuli while excluding available neutral sensory cues (Farb et al., 2010).”

“…that measure subscales mapping onto attention monitoring and acceptance skills (Cognitive and Affective Mindfulness Scale-Revised (CAMS-R): Chadwick et al., 2008; Southampton Mindfulness Questionnaire (SMQ): Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007), in our literature search, we…”

“Similarly, the majority of participants in the reviewed studies had no exposure to mindfulness training interventions, and it’s possible that the interpretation of mindfulness scale items differs between mindfulnesstrained and mindfulness-naïve individuals (Grossman, 2008).”

“We note that some intervention approaches train monitoring and acceptance practices concurrently; however, there is evidence to suggest that attentionmonitoring skills begin to improvemore immediately after practice, while acceptance may take longer to cultivate (Baer, Carmody, & Hunsinger, 2012; Desbordes et al., 201…”

“underlie decreases in symptom severity for patients with anxiety and depressive disorders (Arch et al., 2012; Forman, Herbert, Moitra, Yeomans, & Geller, 2007).”

“…of mindfulness include attention monitoring, but some do not view acceptance as a defining component of mindfulness (cf. Desbordes et al., 2015; Dreyfus, 2011), Tenet #2 focuses on evaluating whether high attention monitoring skills predict specific outcomes at high vs. low levels of…”

“For example, brief acceptance training – which involves monitoring a target object (e.g., momentary pain sensations, feelings of sadness) through an accepting and detached lens – is useful for regulating emotion (cf. Hayes et al., 1999).”

“…of short-term mindfulness training programs (i.e., 5- to 15-minute inductions; 3-4 sessions of training or longer) have been investigated (e.g., Allen et al., 2012; Creswell, Pacilio, Lindsay, & Brown, 2014; Zeidan, Johnson, Diamond, David, & RUNNING HEAD: MONITOR AND ACCEPTANCE…”

“…& Zvolensky, 2009; Wahbeh, Lu, & Oken, 2011); higher well-being, self-esteem, and pro-environmental behavior (Barbaro & Pickett, 2016; Cash & Whittingham, 2010; Christopher & Gilbert, 2010); and better physical health outcomes (Consedine & Butler, 2014; Daubenmier, Hayden, Chang, & Epel,…”

“Indeed, some theoretical perspectives advocate for the power of attention monitoring only (e.g., Bodhi, 2011), and there is additional evidence that focused attention monitoring of the sensory qualities of pain can foster accelerated recovery after a coldpressor task (Cioffi & Holloway, 1993).”

“Monitoring (Observe) also correlated with pro-environmental RUNNING HEAD: MONITOR AND ACCEPTANCE THEORY 21 behavior (as did acceptance; Barbaro & Pickett, 2016).”

“…is exercised in affective contexts, we predict that monitoring increases awareness of affective information, and acceptance facilitates both early engagement with (Teper & Inzlicht, 2013) and disengagement from affective stimuli (Vago & Nakamura, 2011), thus reducing further emotional reactivity.”

“, attention, working memory, emotion regulation; for reviews, see Chiesa, Calati, & Serretti, 2011; Keng, Smoski, & Robins, 2011; Tang, Hölzel, & Posner, 2015), stress reduction (Creswell & Lindsay, 2014), as well as manymental and physical health outcomes (e.g., delaying HIV progression, reducing risk for drug abuse…”

“…factors or lack these intervention elements (e.g., group support) have been linked with affective and physical health outcomes (e.g., Kabat-Zinn et al., 1998; Polusny et al., 2015; Rosenkranz et al., 2013; Taren et al., 2015), suggesting a mindfulness-specific impact on a broad array of outcomes.”

“…Ostafin & Marlatt, 2008; Owens, Walter, Chard, & Davis, 2012; Peters, Eisenlohr-Moul, Upton, & Baer, 2013; Schoorl, Mil-Klinkenberg, & Does, 2015; Thompson & Waltz, 2010; Vujanovic, Youngwirth, Johnson, & Zvolensky, 2009; Wahbeh, Lu, & Oken, 2011); higher well-being, self-esteem, and…”

“…factors or lack these intervention elements (e.g., group support) have been linked with affective and physical health outcomes (e.g., Kabat-Zinn et al., 1998; Polusny et al., 2015; Rosenkranz et al., 2013; Taren et al., 2015), suggesting a mindfulness-specific impact on a broad array of outcomes.”

“As one illustration of this point, when panic disorder patients monitor body sensations (such as their heart rate) during a panic attack, this monitoring can prolong anxiety and panic symptoms (e.g., Ehlers & Breuer, 1996).”

“, 2015); lower worry, rumination, negative cognitions, and emotion dysregulation (Christopher & Gilbert, 2010; Fisak & von Lehe, 2012; Paul et al., 2013; Reese et al., 2015); reductions in clinical symptoms (anxiety, depressive, and personality disorders, eating pathology and substance use, and posttraumatic stress di…”

“increases in Observe skills from pre- to post-training predicted these increases in creative behavior (Baas et al., 2014).”

“…use, and posttraumatic stress disorder) (Adams et al., 2012; Boden et al., 2012; Compare et al., 2012; Fernandez, Wood, Stein, & Rossi, 2010; Hoge et al., 2015; Kalill, Treanor, & Roemer, 2014; Lavender, Gratz, & Tull, 2011; Ostafin & Marlatt, 2008; Owens, Walter, Chard, & Davis, 2012;…”

“…to more rigorously evaluate MAT, more studies are needed to test whether acceptance moderates the association of attention monitoring skills and cognitive, affective, and stress-related outcomes (e.g., Barnes & Lynn, 2010; Desrosiers et al., 2014; Eisenlohr-Moul et al., 2012; Tomfohr et al., 2015).”

“Certainly, studies show that self-reported acceptance alone is associated with lower depressive, anxiety, and stress symptoms (Barnes & Lynn, 2010; Brown et al., 2015; Cash & Whittingham, 2010; Desrosiers et al., 2013; Hamill et al., 2015); lower worry, rumination, negative cognitions, and emotion…”

“…alone is associated with lower depressive, anxiety, and stress symptoms (Barnes & Lynn, 2010; Brown et al., 2015; Cash & Whittingham, 2010; Desrosiers et al., 2013; Hamill et al., 2015); lower worry, rumination, negative cognitions, and emotion dysregulation (Christopher & Gilbert, 2010;…”

“Despite parallels between monitoring and acceptance components as trained in mindfulness interventions and as measured in multi-faceted selfreport mindfulness scales, there is ongoing debate about the validity of self-report mindfulness measures in relation to mindfulness meditation training (Brown, Ryan, Loverich, Bi…”

“…ability to allow momentary events to arise and pass (nonattachment) without evaluating (nonevaluation) them as good or bad (nonjudgment) as highly related and mutually reinforcing RUNNING HEAD: MONITOR AND ACCEPTANCE THEORY 11 features of the broader category of acceptance (Williams & Lynn, 2010).”

“Further, following an 8-week MBCT training, increases in the tendency to monitor (Observe) predicted increases in positive affect (although it's possible that monitoring was correlated with acceptance among these mindfulnesstrained participants; Schroevers & Brandsma, 2010).”

“Similarly, students with high monitoring skills (Observe) and high levels of acceptance (Nonjudgment) reported significantly lower levels of depressive and anxiety symptoms, affective lability, and distress intolerance than students high in monitoring (Observe) with low levels of acceptance (Nonjudgment) (Pearson et a…”

“Systematic desensitization and exposure therapies also involve a willingness to monitor difficult experiences with a stance of acceptance (e.g., Becker & Zayfert, 2001).”

“alcohol use among participants low in monitoring skills compared to those high in monitoring skills (Eisenlohr-Moul et al., 2012).”

“We distinguish acceptance in the mindfulness tradition as equanimity with momentary experiences (in contrast to conceptualizations of acceptance as a resigned acquiescence in response to unwanted situations(Nakamura & Orth, 2005)).”

“Other common interventions that involve mindfulness meditation training include variants of basic MBSR (e.g., Mindfulness-Based Cognitive Therapy (MBCT)) and Emotion Regulation Therapy (ERT; Mennin & Fresco, 2014).”

“…Cash & Whittingham, 2010; Desrosiers et al., 2013; Hamill et al., 2015); lower worry, rumination, negative cognitions, and emotion dysregulation (Christopher & Gilbert, 2010; Fisak & Lehe, 2012; Paul et al., 2013; Reese et al., 2015); reductions in clinical symptoms (anxiety, depressive, and…”

“Although three studies found that acceptance, which may help regulate emotional reactivity and free resources for more flexible task responding, was an important component predicting better performance on the Stroop task (Anicha et al., 2012; Moore & Malinowski, 2009; Teper & Inzlicht, 2013), no studies have reported…”

“…cognitive defusion, allowing burdensome or intrusive negative experiences and memories to be described so that cognitive processing and possibly meaning-making can take place; the patient integrates these difficult experiences into his or her narrative, or lets them go (e.g., Dryden & Still, 2006).”

“…Compare et al., 2012; Fernandez, Wood, Stein, & Rossi, 2010; Hoge et al., 2015; Kalill, Treanor, & Roemer, 2014; Lavender, Gratz, & Tull, 2011; Ostafin & Marlatt, 2008; Owens, Walter, Chard, & Davis, 2012; Peters, Eisenlohr-Moul, Upton, & Baer, 2013; Schoorl, Mil-Klinkenberg, & Does, 2015;…”

“…independent of acceptance, monitoring (Observe) was positively associated with selfesteem and satisfaction with life among healthy students (Christopher & Gilbert, 2010), and with positive growth in the months and years following trauma exposure among police officers (Chopko & Schwartz, 2009).”

“…is exercised in affective contexts, we predict that monitoring increases awareness of affective information, and acceptance facilitates both early engagement with (Teper & Inzlicht, 2013) and disengagement from affective stimuli (Vago & Nakamura, 2011), thus reducing further emotional reactivity.”

“…between monitoring and psychological distress: the tendency to monitor experience (Observe) has been correlated with higher depressive symptoms (Barnes & Lynn, 2010), stress symptoms (Brown, Bravo, Roos, & Pearson, 2015; Hamill et al., 2015), and anxious arousal (Desrosiers, Klemanski, &…”

“, 2015); reductions in clinical symptoms (anxiety, depressive, and personality disorders, eating pathology and substance use, and posttraumatic stress disorder) (Adams et al., 2012; Boden et al., 2012; Compare et al., 2012; Fernandez, Wood, Stein, & Rossi, 2010; Hoge et al., 2015; Kalill, Treanor, & Roemer, 2014; Lave…”

“…Desrosiers et al., 2013; Hamill et al., 2015); lower worry, rumination, negative cognitions, and emotion dysregulation (Christopher & Gilbert, 2010; Fisak & Lehe, 2012; Paul et al., 2013; Reese et al., 2015); reductions in clinical symptoms (anxiety, depressive, and personality disorders, eating…”

“…to more rigorously evaluate MAT, more studies are needed to test whether acceptance moderates the association of attention monitoring skills and cognitive, affective, and stress-related outcomes (e.g., Barnes & Lynn, 2010; Desrosiers et al., 2014; Eisenlohr-Moul et al., 2012; Tomfohr et al., 2015).”

“For example, there is evidence that dispositional mindfulness increases following cognitive behavioral therapies (Boden et al., 2012; Owens et al., 2012), and acceptance skills are particularly important for symptom improvement following interdisciplinary acceptancebased therapy (McCracken, Vowles, & Eccleston, 2005).”

“, 2015) – only correlatedwith anxiety symptoms among student participants reporting high monitoring skills (Observe) and low acceptance (Hamill et al., 2015), suggesting that in the absence of an accepting orientation toward distressing experiences, closely monitoring these experiences may exacerbate them.”

“…interventions are less effective for those RUNNING HEAD: MONITOR AND ACCEPTANCE THEORY 36 inexperienced with acceptance strategies (Blacker et al., 2012; Evans et al., 2014), and among clinical populations, an accepting orientation may be difficult to immediately adopt (Singer & Dobson, 2009).”

“By itself, greater emotional and body awareness has been linked with greater alcohol use (e.g., Leigh & Neighbors, 2009), but this tendency to monitor inner experiences may not be detrimental in predicting substance use when coupled with acceptance skills.”

“…and acceptance in fostering psychological well-being: acceptance appears to be essential for reducing symptoms (and the grasping of positive experiences), while noticing experiences is crucial for appreciating them and building positive states (Garland et al., 2015; Lindsay & Creswell, 2015).”

“(Reese et al., 2015) among participants high in acceptance.”

“, 2015); reductions in clinical symptoms (anxiety, depressive, and personality disorders, eating pathology and substance use, and posttraumatic stress disorder) (Adams et al., 2012; Boden et al., 2012; Compare et al., 2012; Fernandez, Wood, Stein, & Rossi, 2010; Hoge et al., 2015; Kalill, Treanor, & Roemer, 2014; Lave…”

“, 2015); reductions in clinical symptoms (anxiety, depressive, and personality disorders, eating pathology and substance use, and posttraumatic stress disorder) (Adams et al., 2012; Boden et al., 2012; Compare et al., 2012; Fernandez, Wood, Stein, & Rossi, 2010; Hoge et al., 2015; Kalill, Treanor, & Roemer, 2014; Lave…”

“…interventions are less effective for those RUNNING HEAD: MONITOR AND ACCEPTANCE THEORY 36 inexperienced with acceptance strategies (Blacker et al., 2012; Evans et al., 2014), and among clinical populations, an accepting orientation may be difficult to immediately adopt (Singer & Dobson, 2009).”

“Further, whereas high monitoring skills (Observe) correspond with a strong relationship between potentially stressful life events and distress symptoms among non-meditators, stressful events do not predict distress among meditators high in monitoring skills (Neale-Lorello & Haaga, 2015).”

“Monitoring (Observe) has also been associated with poorer subjective health and more physician visits for psychological and physical health (Consedine & Butler, 2014); a strong tendency to monitor may increase focus on somatic sensations and intensify them unless viewed with acceptance.”

“…interventions are less effective for those RUNNING HEAD: MONITOR AND ACCEPTANCE THEORY 36 inexperienced with acceptance strategies (Blacker et al., 2012; Evans et al., 2014), and among clinical populations, an accepting orientation may be difficult to immediately adopt (Singer &…”

“More broadly, mindfulness skills may initiate ripple effects (31), with benefits extending to a range of personal and social outcomes that can improve health (16, 32).”

“By fostering awareness and nonreactivity toward momentary affective experiences, mindfulness alters how one relates to negative affect; unpleasant and stressful experiences are allowed to arise and pass without interference (Brown, Ryan, & Creswell, 2007; Lindsay & Creswell, 2017).”

“However, mindfulness requires conscious effort and can be difficult to maintain, particularly for novice meditators who already expend greater cognitive resources to control their self-regulatory skills [7-9].”

“Although we have previously described these theoretical perspectives (5,12,40), here we provide some updates and links to biobehavioral processes relevant to biobehavioral medicine researchers.”