Do Mindfulness Meditation Participants Do Their Homework? and Does It Make a Difference? A Review of the Empirical Evidence

Article excerpt

Mindfulness-based interventions have been shown to alleviate symptoms of a wide range of physical and mental health conditions. Regular between-session practice of mindfulness meditation is among the key factors proposed to produce the therapeutic benefits of mindfulnessbased programs. This article reviews the mindfulness intervention literature with a focus on the status of home practice research and the relationship of practice to mindfulness program outcomes. Of 98 studies reviewed, nearly one-quarter (N = 24) evaluated the associations between home practice and measures of clinical functioning, with just over half (N = 13) demonstrating at least partial support for the benefits of practice. These findings indicate a substantial disparity between what is espoused clinically and what is known empirically about the benefits of mindfulness practice. Improved methodologies for tracking and evaluating the effects of home practice are recommended.

Keywords: mindfulness-based stress reduction; mindfulness-based cognitive therapy; practice; homework

There has been burgeoning interest in mindfulness meditation practices within educational, employment, health, and psychiatric settings. Rooted in Asian spiritual practices, mindfulness programs were first secularized with the pioneering work of Kabat-Zinn (1990), initially as the Stress Reduction and Relaxation Program and subsequently as mindfulness- based stress reduction (MBSR; Kabat-Zinn, 1990; Kabat-Zinn et al., 1992). Recent adaptations of mindfulness programs have included mindfulness-based cognitive therapy (MBCT; Segal, Williams, & Teasdale, 2002), attentional control therapy (McMillan, Robertson, Brock, & Chorlton, 2002), mindfulness-based relationship enhancement for couples (Carson, Carson, Gil, & Baucom, 2004), and intensive mindfulness-based retreats for addictive behavior (Bowen et al., 2006; Ostafin et al., 2006). A number of favorable mental health outcomes have been associated with mindfulness-based training programs, including decentered, nonjudgmental awareness of everyday experience (Segal et al., 2002), improved quality of life, personal growth, openness to change, spirituality, and self-control (e.g., Mackenzie, Carlson, Munoz, & Speca, 2007). Beneficial effects also have been documented for a number of physical and mental health conditions, including anxiety (Kabat-Zinn et al., 1992; Toneatto & Nguyen, 2007), depression relapse (Segal et al., 2002), chronic pain (Kabat-Zinn, 1990), substance abuse (Bowen et al., 2006), problem gambling (Toneatto, Vettese, & Nguyen, 2007), eating disorders (Kristeller & Hallett, 1999), moderate to severe psoriasis (Kabat-Zinn et al., 1998), and traumatic brain injury (Bedard et al., 2003).

As conveyed to mindfulness program participants, mindfulness is a set of skills that involves a particular way of paying attention, in the present moment, and nonjudgmentally (Kabat-Zinn, 1990; Segal et al., 2002). Mindfulness is taught in the context of group sessions and ostensibly improves in the context of daily home practice. Within sessions, participants are guided through a series of meditations, including the ?gbody scan,?h sitting meditation, gentle yoga postures, walking meditation, and breath awareness exercises, such as the ?g3-minute breathing space?h (Segal et al., 2002). During sessions, which typically occur weekly over 8 weeks, participants also are assigned between-session homework that involves 30 to 60 minutes of daily mindfulness practice, which may be tailored according to specific clinical problems or life circumstances (e.g., see Chadwick, Taylor, & Abba, 2005; see also Samuelson, Carmody, Kabat- Zinn, & Gratt, 2007).

The therapeutic effects of mindfulness-based programs have been attributed, in large part, to participants?f engagement in regular and sustained practice. As with cognitive-behavioral approaches, mindfulness programs view between-session as well as postprogram homework as critical to maximizing the benefits of treatment. …