Within the past two decades, several mindfulness-oriented interventions have been developed [126, 127]. The four main treatment programs that attempt to teach mindfulness are Mindfulness Based Stress Reduction (MBSR) [2], Mindfulness Based Cognitive Therapy (MBCT) [117], Acceptance and Commitment Therapy (ACT) [128], and Dialectic Behavior Therapy (DBT) [129]. Each program has different origin in relation to the theoretical influence and populations treated. And although MBSR and MBCT are organized around the principal idea of mindfulness, ACT and DBT each have a central mindfulness element as well [130]. MBCT, ACT, and DBT are often placed in the category of “third wave” behavioral and cognitive interventions [131, 132], and some authors also place MBSR in this category [133]. The “third wave” of
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behavioral and cognitive interventions has been typified as placing more emphasis on the context and function of cognitions, emotions, and behavior, and paying greater attention to contextual and experiential processes of change, than traditional CBT [131]. Many “third wave” approaches are grounded in the idea that paying mindful attention to, and cultivate acceptance of present moment experience, may develop a more healthy relationship with individuals´ experiences, which in turn can lead to reduction in psychological distress [134].
MBSR has played the key role among modern versions of mindfulness practice in introducing mindfulness into the field of medicine and psychology [130]. Further interventions that have subsequently been developed, like MBCT, ACT and DBT, are influenced by the MBSR. MBSR is the only modern mindfulness intervention that is overtly rooted in Buddhist tradition. Nevertheless, it remains a secular intervention in spite of its important Buddhist derivations [127]. In short, MBSR was started for treating chronically ill patients, and is organized as a manualized eight-to ten-week group intervention program. Several mindfulness meditation skills are taught, and the main techniques are: body scan, sitting meditation and Hatha yoga practice [2]. Participants are taught to practice mindfulness skills for at least 45 minutes per day outside group meetings [135]. Mindfulness in terms of MBSR is used in the MVRP investigated in the present thesis, and is described more in detail in section 3.6.1.
MBCT is an eight-week manualized group intervention program adapted from the MBSR model [117]. It was developed in the 1990s, as a secular, clinical
intervention for the prevention of relapses of major depression. MBCT teaches the mindfulness practices of MBSR, and a further source for MBCT is Cognitive Behavioral Therapy (CBT) [136]. The mindfulness aspect in MBCT is learning to see that
“thoughts are not facts”, and that it´s possible to let thoughts come and go, instead of trying to argue them out of existence, like in traditional CBT. MBCT differ from MBSR in that: MBCT includes specific exercises and techniques derived from CBT; provide material about major depression; and the use of a fourth formal practice named “the three-minute breathing space” [127].
ACT is theoretically based in contemporary behavior analysis as it is related to the contextual world view and the use of language [137, 138]. Although ACT does not incorporate mindfulness meditation exercises, it is included among mindfulness- oriented interventions because several of its strategies (e.g., helping patients cultivate present-centered awareness and acceptance) is consistent with that of
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other mindfulness approaches [126]. ACT has been delivered in both individual and group settings, with durations from one day to 16 weeks. The main components of ACT are: acceptance (allow experience to be what it is while effectively engaged), cognitive defusion (our thoughts are just thoughts, not what we interpret them to be), contact with the present moment, self as context (identify with the observer of thoughts), values (rededicate one`s life to what gives meaning), and committed action (development of patterns of effective action linked to chosen values) [137]. ACT aims to foster acceptance of unwanted thoughts and feelings [127]. Thus, the central aim of ACT is to develop better psychological flexibility by teaching skills that increase an individual`s enthusiasm to come into fuller contact with their
experiences, acknowledge their values, and commit to behaviors that are consistent with those values [130].
DBT is a multifaceted approach to treat patients with borderline personality who have difficulty regulating emotions [129]. It is based on a dialectic world-view, and the most central dialectic in DBT is the relationship between acceptance and change. A wide range of cognitive and behavioral treatment procedures designed to change thoughts, emotions, or behaviors, are included in DBT [135]. Mindfulness skills are taught in the context of a skill-training group as an exposure strategy aiming to reduce avoidance of difficult emotions and fear responses, and as a way of helping patients increase self-acceptance [126]. The mindfulness skills are similar to those targeted in MBSR, but the concepts are organized somewhat different, and DBT does not prescribe a specific frequency or duration of mindfulness practice. The
mindfulness skills in DBT consists of three “what” skills (observe, describe, and
participate), and three “how” skills (nonjudgmentally, one-mindfully, and effectively) [126, 135]. Spesific exercises that are used to foster mindfulness include bringing mindful awareness into daily activites, observing breath by counting, and visualizing thoughts, feelings and sensations as they were clouds passing by [126].
All these mindfulness approaches have a common basis in that they include explicit focus on present centered awareness. One of the main differences between the approaches is that inteventions differ in how they teach mindful awareness. For example, both MBSR and MBCT involve formal meditation training, whereas ACT and DBT on the other hand incorporate a range of informal mindfulness exercises in their treatment approach [126]. Furthermore, while ACT and DBT are concerned with the modification of cognitions, which, in turn, may alter the way the individual perceives
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internal and external stimuli – ancient Buddhist meditations, such as Zen, is mainly oriented toward direct perception of pure experience (e.g., sensations, sound). MBSR, and especially MBCT, may be placed somewhere between these two extremes. All modern mindfulness approaches above mentioned have in common that they are directed to the reduction of symptoms of a specific underlying disorder (such as stress or major depression) [127].