Dismantling Mindfulness-Based Cognitive Therapy: Creation and validation of 8-week focused attention and open monitoring interventions within a 3-armed randomized controlled trial

Abstract

Background: While mindfulness-based interventions (MBIs) employ two distinct practices, focused attention (FA) and open monitoring (OM), the integrated delivery of these practices in MBIs precludes understanding of their practice-specific effects or mechanisms of action. The purpose of this study is to isolate hypothesized active ingredients and practice-specific mechanistic target engagement by creating structurally equivalent interventions that differ only by the active ingredient (meditation practice) offered and to test whether the hypothesized components differentially engage the mechanistic targets that they are purported to engage.

Methods: Participants were intended to be representative of American meditators and had mild to severe affective disturbances. Measures of structural equivalence included participant-level (sample characteristics), treatment-level (program structure and duration, program materials, class size, attendance, homework compliance, etc.), and instructor-level variables (training, ratings and adherence/fidelity). Measures of differential validity included analysis of program materials and verification of differential mechanistic target engagement (cognitive and affective skills and beliefs about meditation acquired by participants after the 8-week training).

Results: The results indicate successful creation of structurally equivalent FA and OM programs that were matched on participant-level, treatment-level, and instructor-level variables. The interventions also differed as expected with respect to program materials as well as mechanistic targets engaged (skills and beliefs acquired).

Conclusions: These validated 8-week FA and OM training programs can be applied in future research to assess practice-specific effects of meditation.

Trial registration: ClinicalTrials.gov NCT01831362.

Keywords: Dismantling; Focused attention; Meditation; Mindfulness; Open monitoring.

Conflict of interest statement

Conflict of Interest

The authors declare no conflict of interest.

Copyright © 2017 Elsevier Ltd. All rights reserved.

Figures

Fig. 1

CONSORT flow diagram. FA = Focused Attention; MBCT = Mindfulness-Based Cognitive Therapy; OM = Open Monitoring.

Fig. 2

The acquisition of cognitive and affective skills and beliefs about meditation following the 8-weeks intervention for all three treatments. The Y axes (bar height) represent the degree of skill/belief acquisition from pre- to post-treatment in Cohen’s d effect size units. The magnitude of difference in skill/belief acquisition between FA and OM treatments is represented by a separate set of Cohen’s d effect sizes on top of each set of bars. (a) Skills for which OM participants demonstrated greater increases than FA participants (b) Skills for which FA participants demonstrated greater increases than OM participants (c) Changes in beliefs about meditation that reflected divergence between FA and OM groups. * p

Fig. 2

The acquisition of cognitive and affective skills and beliefs about meditation following the 8-weeks intervention for all three treatments. The Y axes (bar height) represent the degree of skill/belief acquisition from pre- to post-treatment in Cohen’s d effect size units. The magnitude of difference in skill/belief acquisition between FA and OM treatments is represented by a separate set of Cohen’s d effect sizes on top of each set of bars. (a) Skills for which OM participants demonstrated greater increases than FA participants (b) Skills for which FA participants demonstrated greater increases than OM participants (c) Changes in beliefs about meditation that reflected divergence between FA and OM groups. * p

Fig. 2

The acquisition of cognitive and affective skills and beliefs about meditation following the 8-weeks intervention for all three treatments. The Y axes (bar height) represent the degree of skill/belief acquisition from pre- to post-treatment in Cohen’s d effect size units. The magnitude of difference in skill/belief acquisition between FA and OM treatments is represented by a separate set of Cohen’s d effect sizes on top of each set of bars. (a) Skills for which OM participants demonstrated greater increases than FA participants (b) Skills for which FA participants demonstrated greater increases than OM participants (c) Changes in beliefs about meditation that reflected divergence between FA and OM groups. * p