Second-Generation Mindfulness-Based Interventions: Toward More Authentic Mindfulness Practice and Teaching
In recent years, a dialogue has emerged concerning the extent to which mindfulness-based interventions (MBIs) teach and embody the essence of mindfulness according to longstanding conceptualizations of the technique. Traditionally, mindfulness was an integral component of a broad spectrum of contemplative practices, that when practiced collectively and correctly, reflected a rounded path of spiritual practice (Shonin et al. 2014). However, as part of its recent integration into various applied settings, it appears that some MBIs have largely isolated mindfulness from the techniques and practice principles that traditionally supported it. In such cases, a question that arises is whether mindfulness should still be called “mindfulness”, or whether in some of its modern interventional forms, it has been transposed into an “attention-based psychological technique” (Van Gordon et al. 2016).
Regardless of the answer to this question, evidence from thousands of empirical studies suggest that this transposed technique has applications for improving health and human performance. Thus, the aforementioned dialogue has less to do with whether MBIs have demonstrable efficacy, and more to do with whether (i) there is sufficient transparency and scrutiny concerning the claims made by some MBI proponents regarding the authenticity of the technique they purport to teach, (ii) there are contexts in which a more traditional intervention-based form of mindfulness would be more appropriate or efficacious, and (iii) some prospective mindfulness practitioners would welcome more choice in terms of the degree to which an MBI follows the traditional practice model.
At one extreme of the mindfulness authenticity dialogue is the claim that some MBIs teach a highly superficial and watered-down version of mindfulness, colloquially referred to as McMindfulness (Purser 2019). The essence of the McMindfulness assertion appears to be that some modern renderings of mindfulness have contributed to the creation of a “mindfulness-ego”, that enables cliques of mindfulness teachers and stakeholders to profit from the integration of (what they claim to constitute) mindfulness into a range of life and work contexts. Such comportment and usage of mindfulness amounts to the misappropriation of Buddhist teachings, with damaging consequences for scientific, social scientific and healthcare disciplines, as well as Buddhism more generally (Shonin et al. 2013). However, as part of seeking to address one form of ego, it is easy to fall into the trap of creating another. In other words, the McMindfulness initiative, despite no doubt having intentions of seeking to raise awareness of the inadequacies of some current approaches to mindfulness practice and teaching, could easily become misguided due to seeking to establish and propagate its own legitimacy. In the event such a “McMindfulness ego” were to emerge, it would only serve to foster additional superficiality and confusion in terms of what constitutes authentic mindfulness practice.
Second-Generation Mindfulness-Based Interventions
In response to some of the aforementioned issues, there has been growing interest into an intervention-based form of mindfulness that more closely embodies how the technique was conceptualized by ancient contemplative traditions. Accordingly, various forms of second-generation mindfulness-based interventions (SG-MBIs) have been formulated and subjected to empirical investigation. The precise criteria of what constitutes an SG-MBI is still undergoing refinement, but they are distinct from first-generation mindfulness-based interventions (FG-MBIs) due to typically meeting most or all of the following criteria: (i) being overtly psycho-spiritual or spiritual in nature, (ii) employing a greater range of (normally secularized) meditative techniques, (iii) featuring ethics as a key component of the taught program, and (iv) using an instructor training program that normally requires several years of supervised mindfulness practice (Van Gordon et al. 2015). Whereas FG-MBIs generally adopt Kabat-Zinn’s (1994) definition of mindfulness as paying “attention in a particular way: on purpose, in the present moment, and non-judgmentally” (p. 4), a definition of mindfulness according to the SG-MBI model has been proposed as the “process of engaging a full, direct, and active awareness of experienced phenomena that is: (i) psycho-spiritual in aspect, and (ii) maintained from one moment to the next” (Van Gordon et al. 2015, p. 592).
The emergence of SG-MBIs appears to be consistent with the wider evolution of Buddhist-inspired contemplative science research. More specifically, as the present authors have noted previously (Van Gordon et al. 2017), an initial phase of empirical investigation began in the early 1980s, which was primarily concerned with understanding the construct and applications of mindfulness as well as related attentional contemplative processes. The next phase of empirical investigation began approximately 25 years later in 2005 and focussed on contemplative approaches involving ethical and empathic awareness, such as loving-kindness and compassion meditation. However, in the last six years, a third phase of research appears to have gradually emerged, concerned with investigating Buddhist wisdom-based concepts such as non-attachment, impermanence, non-self and emptiness. Incidentally, this phasic evolution happens to be consistent the Buddhist three trainings (Sanskrit: trishiksha) principle, which categories contemplative practices into those focussing on (i) meditation, (ii) ethics, and (iii) wisdom (Van Gordon et al. 2017). Due to emerging during the most recent of the aforementioned evolutionary developments, SG-MBIs have benefitted from being able to integrate evidence-based contemplative techniques from each of the three phases.
SG-MBIs appear to share some design features with FG-MBIs, such as typically being between 4 and 12 weeks long as well as incorporating weekly group practice sessions, lecture and psycho-education components, guided meditation exercises, group discussion, and at-home practice elements. Indeed, all of these features are present in Meditation Awareness Training (MAT), which reflects one of the first SG-MBIs to be subjected to empirical evaluation (Van Gordon et al. 2014). However, MAT also includes one-to-one discussion sessions with the program facilitator as well as contemplative techniques intended to foster, for example, ethical and impermanence awareness, loving-kindness and compassion, insight into emptiness, and an understanding of how pervasive conditions such as ontological addiction (i.e., self-addiction) foster suffering (Van Gordon et al. 2018). Furthermore, prior to receiving training in MAT and for transparency purposes, all participants are informed that the intervention is deemed by its founders to (i) include a spiritual or psycho-spiritual component, (ii) make direct use of Buddhist principles, but that it is (iii) not intended to teach Buddhism per se.
The purpose of this Special Section was to solicit high-quality research papers that advance scientific understanding regarding the applications, mechanisms of action, and limitations of SG-MBIs. Several papers sought to directly compare the effects of an SG-MBI versus FG-MBI in a given population setting. More specifically, a community sample randomized controlled trial (RCT) found that while there were no differences in effects on empathy, the SG-MBI led to greater increases in self-compassion and subjective wellbeing, whereas the FG-MBI elicited greater improvements in mindfulness (Bayot et al. 2019). Another non-clinical sample head-to-head study found that while both the FG-MBI and SG-MBI led to improvements in stress, life satisfaction and self-awareness, the SG-MBI out-performed the FG-MBI on personal growth and prosocial behaviour outcomes (i.e., donating money to charity) (Chen and Jordan 2019).
A further head-to-head study compared an adapted version of Mindfulness-based Cognitive Therapy (MBCT) with Mindfulness-based Stress Reduction for people with co-morbid depression and cardiovascular disorders (Alsubaie et al. 2019). The adapted MBCT intervention appeared to integrate a number of SG-MBI components, such as curiosity and inquiry into aspects of self (e.g., thoughts and illness), as well as teaching compassionate and wisdom responses. The adapted MBCT intervention out-performed MBSR in terms of reductions in depression.
Three SG-MBIs with notable compassion components were included in the Special Section. A non-randomized controlled trial assessed the effects of an SG-MBI known as Attachment-Based Compassion Therapy (ABCT) on self-compassion and attachment style in a non-clinical sample (Navarro-Gil et al. 2019). Compared to a wait-list control, ABCT led to significant improvements in levels of self-compassion, mindfulness, psychological disturbance, experiential avoidance, anxiety and secure attachment style. Another SG-MBI making extensive use of compassion techniques also followed a non-randomized controlled design and demonstrated that the intervention fostered improvements in veteran levels of post-traumatic stress disorder (Lang et al. 2019). Another study showed that an SG-MBI’s effectiveness for reducing fear of compassion for self was influenced by baseline levels of emotion expression suppression and perceived stress, thus advancing understanding in terms of participant characteristics most likely to benefit from the intervention (Goldin and Jazaieri 2019).
An SG-MBI focussing on the application of mindfulness for gifted children demonstrated improvements in emotional abilities and reductions in negative symptoms, with positive outcomes being maintained at 12-month follow-up (Turanzas et al. 2019). Based on a 40-week RCT, an SG-MBI known as Mindfulness-Based Positive Behaviour Support out-performed a non-mindfulness intervention for helping caregivers cope with the demands of caring for individuals with intellectual and developmental disabilities (Singh et al. 2019).
A further study showed that brief mindfulness techniques used in an SG-MBI led to significant reductions in pain symptomatology and psychological distress in chronic pain patients (Cayoun et al. 2019). Another study demonstrated the benefits of participating in an SG-MBI mindful-dancing program, in which the intervention’s effects on compassion were found to be fully mediated by shared flow and perceived emotional synchrony (Pizarro et al. 2019).
A qualitative study of experienced Vipassana Mahasi meditators also supported the inclusion of insight- and ethics-based contemplative techniques within MBIs. The study showed that participants perceived meditation as a means of undermining maladaptive responses through the use of mindfulness, other contemplative techniques, and non-attachment to self (Ekici et al. 2019). Another study advancing understanding and potential design features of SG-MBIs involved combining guided imagery and mindfulness practices to facilitate mentalization in a psychotherapeutic context, with the intention of fostering insight into relationship attachment processes (Jain and Fonagy 2019). A further important contribution was provided via the elucidation of a Wheel of Mindfulness model, which provided a theoretical framework for integrating SG-MBIs and Buddhist wisdom principles into organizational settings (King and Badham 2019).
Evidence emerging during the last six years indicates that SG-MBIs can be an efficacious complement to FG-MBIs by increasing the choice of MBIs that are available to prospective mindfulness practitioners. However, more head-to-head studies are needed to determine the particular context and participant characteristics for which a given FG-MBI or SG-MBI is likely to be the optimum approach. More work is also needed to provide post-intervention practice support for SG-MBI (and FG-MBI) participants, as a 4–12-week intervention can realistically only serve to introduce some basic practice principles that need to be refined and internalized during future months and years.
On the surface, SG-MBIs appear to teach mindfulness in a manner more consistent with traditional contemplative approaches, without necessarily requiring a participant to have an affinity for learning Buddhism. However, an important feature of MBIs, or indeed any form of psychotherapeutic intervention, is the extent to which the instructor is able to impart an embodied understanding of the technique in question (Shonin et al. 2015). In other words, while SG-MBIs typically include practice components traditionally deemed to maximize the effectiveness of mindfulness, in the hands of an inadequate instructor, SG-MBIs are not only likely to have limited effectiveness, but may end up contributing to one of the key problems they seek to address (i.e., McMindfulness).
Author Contribution Statement
WVG and ES were involved in the conception and writing of the paper.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
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