Toronto Mindfulness Scale Research Articles

Mechanisms of Mindfulness in Those with Higher and Lower Levels of Autism Traits

The effects of brief mindfulness induction on a central trait of autism spectrum disorder (over-selective attention) were examined in order to assess whether different mechanisms act in those with lower and higher levels of autism traits, and determine which intervention may be most appropriate for individuals with different sets of symptoms. Two hundred and 24 volunteer participants (110 male; 114 female) were assessed for levels of autism traits (autism quotient; AQ), anxiety and depression (Hospital Anxiety and Depression Scales), and mindful awareness (Toronto Mindfulness Scale). They were randomly assigned to mindfulness, relaxation, or no-intervention groups. After three 10-min sessions, held on alternate days, participants underwent simultaneous discrimination training between two two-element compound stimuli (AB+ CD−), followed by an extinction test (AvC, AvD, BvC, BvD) to determine the amount of over-selectivity present. Levels of depression, anxiety, and mindfulness were re-assessed. Participants with greater autism traits demonstrated greater over-selectivity, than those with lower autism traits. Mindfulness reduced over-selectivity, and did so independently of the level of AQ displayed by the participants. For lower scoring AQ participants, mindfulness worked more effectively than relaxation. In contrast, for participants with higher AQ scores, there was little difference between the impact of mindfulness and relaxation. The latter group displayed no improvement in mindful awareness. Mindfulness induction can be effective, but may work through different mechanisms for those with higher and lower autism traits, and consideration should be given as to whether this intervention may be the most suitable in all cases where autism traits are present.

A preliminary investigation of the effects of one yoga session for service recipients in a behavioral health intensive outpatient program

This was an investigation of the feasibility and effectiveness of a brief yoga intervention (one session) within an intensive outpatient program (IOP) for service recipients diagnosed with various psychiatric disorders. Participants (N = 26) completed the Toronto Mindfulness Scale (TMS) and the Positive and Negative Affect Schedule (PANAS). Data was collected before and after one yoga session and follow-up data was collected via mail after discharge from the IOP. Scores indicated that negative affect significantly decreased and positive affect significantly increased from pre to post yoga session. Mindfulness scores significantly increased from pre to post yoga session. Though the results of this study supported that a yoga intervention is both feasible and effective within an IOP, collection of follow-up data after discharge via mail was not as feasible. The results of this preliminary investigation support a larger and longitudinal study to further examine yoga as a treatment modality with this clinical population.

Improving the culture of safety on a high‐acuity inpatient child/adolescent psychiatric unit by mindfulness‐based stress reduction training of staff

The purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness-based stress reduction (MBSR) training program on a highacuity psychiatric inpatient unit. A one-group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately posttraining and at 2months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale. The MBSR program reduced staff stress across the 2-month post-training period and increased staff mindfulness immediately following the brief training period of 8days, and across the 2-month post-training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call-ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2months following the training period. A brief MBSR training program offered to an interprofessional staff of a high-acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety.

Mindfulness-Based Stress Reduction in Women with Overweight or Obesity: A Randomized Clinical Trial.

ObjectiveTo evaluate the feasibility and cardiometabolic effects of mindfulness‐based stress reduction (MBSR) in women with overweight or obesity.MethodsEighty‐six women with BMI ≥ 25 kg/m2 were randomized to 8 weeks of MBSR or health education and followed for 16 weeks. The primary outcome was the Toronto Mindfulness Scale. Secondary outcomes included the Perceived Stress Scale‐10, fasting glucose, and blood pressure.ResultsCompared to health education, the MBSR group demonstrated significantly improved mindfulness at 8 weeks (mean change from baseline, 4.5 vs. −1.0; P = 0.03) and significantly decreased perceived stress at 16 weeks (−3.6 vs. −1.3, P = 0.01). In the MBSR group, there were significant reductions in fasting glucose at 8 weeks (−8.9 mg/dL, P = 0.02) and at 16 weeks (−9.3 mg/dL, P = 0.02) compared to baseline. Fasting glucose did not significantly improve in the health education group. There were no significant changes in blood pressure, weight, or insulin resistance in the MBSR group.ConclusionsIn women with overweight or obesity, MBSR significantly reduces stress and may have beneficial effects on glucose. Future studies demonstrating long‐term cardiometabolic benefits of MBSR will be key for establishing MBSR as an effective tool in the management of obesity.

Measuring Mindfulness: Applying Generalizability Theory to Distinguish between State and Trait

Mindfulness can be conceptualized as either a state or a trait, but currently, there is no reliable psychometric method to distinguish clearly between the two in psychological measures. Notwithstanding the clinical effectiveness of mindfulness, any specific element of mindfulness treatment can only be evaluated by comparing state and trait changes using techniques that allow such changes to be measured. Generalizability Theory (GT) is a suitable method to differentiate between state and trait variance components, and its application is illustrated here with an empirical example using the Toronto Mindfulness Scale (TMS). Person × occasion interaction is a marker of individual state changes and should explain the largest amount of variance in a valid state measure. To assess state variability, data were collected on three separate occasions: (i) after a holiday, (ii) immediately after a mindfulness exercise, and (iii) before a stressful event (i.e., exam). Generalizability analysis was applied to examine sources of true and error variances. The TMS captured a larger amount of variance attributed to a state and only a small amount associated with trait mindfulness, which is consistent with the purpose of the measure. This study has demonstrated that Generalizability Theory can be usefully applied to distinguish between state and trait components in a measure, and it is recommended as an appropriate psychometric method to validate state and trait measurement tools. These findings have far-reaching implications to improve the accuracy of the distinction between state and trait in mindfulness measurement and other areas of psychological assessment.

An Examination of Concurrent and Incremental Validity of Four Mindfulness Scales

General consensus among psychologists supports the beneficial effects of mindfulness in the treatment of a wide range of clinical conditions such as personality, mood, and anxiety disorders. Several scales used to assess this psychological construct, mainly rooted in Eastern traditions, are currently available to researchers and clinicians. However, the conceptualization and measurement of mindfulness has been considerably diverse. The present study examines the concurrent and incremental validity of four scales: the Philadelphia Mindfulness Scale (PHLMS), the Toronto Mindfulness Scale (TMS), the Five-Facet Mindfulness Questionnaire (FFMQ), and the Langer Mindfulness Scale (LMS). Two independent samples of 176 adults and 397 students, respectively, were recruited. With few exceptions, results were consistent across the two samples and indicated that measures based on an Eastern conceptualization of mindfulness (TMS, PHLMS, and FFMQ) show a different pattern of association with the chosen outcomes compared to the LMS, which is based on a Western conceptualization. Overall, the PHLMS showed the strongest predictive effects and the LMS the weakest in terms of both number of predicted criteria and average effect size. Implications for research and practice are discussed.

Administration and Assessment of Brief Mindfulness Practice in the Field: a Feasibility Study Using Ecological Momentary Assessment

Measuring the construct, component processes, and practice of mindfulness remains challenging. This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported mindfulness and performance-based cognition. Adult community smokers were randomly assigned to a Brief-MP or Control (sham meditation) group. Participants carried a personal digital assistant (PDA) for 2 weeks and were instructed to initiate 20 min of meditation (or control) training on the PDA daily, and to complete an assessment of mindfulness and cognition immediately afterwards. Additionally, participants completed assessments at random times up to four times per day. Primary outcome variables were feasibility and acceptability, state and trait mindfulness, a decentered perspective to depressive stimuli, and attentional bias to smoking stimuli. Thirty-seven participants provided EMA data totaling 1874 assessments. Fifteen of 18 Brief-MP participants completed over 75 % of mindfulness trainings in the field. The majority of Brief-MP participants endorsed favorable descriptions of the intervention: “acceptable,” and “willing to recommend to a friend”. Linear Mixed Model analyses on EMA data revealed that, over time, Brief-MP (vs. Control) increased self-reported Curiosity and Decentering assessed by the Toronto Mindfulness Scale. Brief-MP did not change trait mindfulness or cognition. In sum, Brief-MP administered in the field was acceptable and increased state mindfulness.

A Moment of Mindfulness: Computer-Mediated Mindfulness Practice Increases State Mindfulness.

Three studies investigated the use of a 5-minute, computer-mediated mindfulness practice in increasing levels of state mindfulness. In Study 1, 54 high school students completed the computer-mediated mindfulness practice in a lab setting and Toronto Mindfulness Scale (TMS) scores were measured before and after the practice. In Study 2 (N = 90) and Study 3 (N = 61), the mindfulness practice was tested with an entirely online sample to test the delivery of the 5-minute mindfulness practice via the internet. In Study 2 and 3, we found a significant increase in TMS scores in the mindful condition, but not in the control condition. These findings highlight the impact of a brief, mindfulness practice for single-session, computer-mediated use to increase mindfulness as a state.

Mindfulness during romantic conflict moderates the impact of negative partner behaviors on cortisol responses

This study was designed to test whether romantic partners' mindfulness—present moment, nonjudgmental awareness—during a conflict discussion could buffer the effects of negative partner behaviors on neuroendocrine stress responses. Heterosexual couples (n=88 dyads) provided 5 saliva samples for cortisol assay during a laboratory session involving a conflict discussion task. Conflict behaviors were coded by outside observers using the System for Coding Interactions in Dyads, and partners rated their mindfulness during the task using the Toronto Mindfulness Scale. Interactions tested using multilevel modeling revealed that participants with higher levels of mindfulness during the conflict showed either quicker cortisol recovery or an absence of slowed recovery in the presence of more negative partner behaviors. Whereas the attitudinal component of mindfulness (curiosity) moderated effects of negative partner engagement in the conflict (i.e., attempts to control, coerciveness, negativity and conflict), the attentional component of mindfulness (decentering) moderated the effect of partner disengagement (i.e., withdrawal). These findings lend support to the idea that mindfulness during a stressful interaction can mitigate the physiological impacts of negative behaviors.

The effect of a brief mindfulness induction on processing of emotional images: an ERP study.

The ability to effectively direct one’s attention is an important aspect of regulating emotions and a component of mindfulness. Mindfulness practices have been established as effective interventions for mental and physical illness; however, the underlying neural mechanisms of mindfulness and how they relate to emotional processing have not been explored in depth. The current study used a within-subjects repeated measures design to examine if focused breathing, a brief mindfulness induction, could modulate event-related potentials (ERPs) during emotional image processing relative to a control condition. We related ERP measures of processing positive, negative, and neutral images (the P300 and late positive potential – LPP) to state and trait mindfulness measures. Overall, the brief mindfulness induction condition did not influence ERPs reflecting emotional processing; however, in the brief mindfulness induction condition, those participants who reported feeling more decentered (a subscale of the Toronto Mindfulness Scale) after viewing the images had reduced P300 responses to negative versus neutral images.

Mindfulness-based stress reduction for overweight/obese women with and without polycystic ovary syndrome: Design and methods of a pilot randomized controlled trial

IntroductionMindfulness-based stress reduction (MBSR) may be beneficial for overweight/obese women, including women with polycystic ovary syndrome (PCOS), as it has been shown to reduce psychological distress and improve quality of life in other patient populations. Preliminary studies suggest that MBSR may also have salutary effects on blood pressure and blood glucose. This paper describes the design and methods of an ongoing pilot randomized controlled trial evaluating the feasibility and effects of MBSR in PCOS and non-PCOS women who are overweight or obese (NCT01464398). Methods and designEighty six (86) women with body mass index≥25 kg/m2, including 31 women with PCOS, have been randomized to 8weeks of MBSR or health education control, and followed for 16weeks. The primary outcome is mindfulness assessed with the Toronto Mindfulness Scale. Secondary outcomes include measures of blood pressure, blood glucose, quality of life, anxiety and depression. DiscussionOur overall hypothesis is that MBSR will increase mindfulness and ultimately lead to favorable changes in blood pressure, blood glucose, psychological distress and quality of life in PCOS and non-PCOS women. This would support the integration of MBSR with conventional medical treatments to reduce psychological distress, cardiovascular disease and diabetes in PCOS and non-PCOS women who are overweight or obese.

Psychometric Validation of the Toronto Mindfulness Scale – Trait Version in Chinese College Students

The Toronto Mindfulness Scale (TMS; Lau et al., 2006) has been widely used to assess the state mindfulness of participants after practicing mindfulness. Recently, a trait version of the Toronto Mindfulness Scale was developed and initially validated (TMS-T; Davis et al., 2009). We further examined the psychometric properties of TMS-T using three hundred and sixty-eight Chinese college students (233 females and 135 males) from a public university in Hong Kong. We found that factor analyses failed to support the existence of two-dimensional structure of the Chinese version of the TMS-T (C-TMS-T). The model fit indices indicated a marginal model fit, and the concurrent and convergent validities of the C-TMS-T were not confirmed. The moderate item-to-subscale fit of the decentering subscale indicated that its structural validity was not satisfactory. In addition, the internal consistency coefficient of the decentering subscale using composite reliability (p = .61) was under the acceptable level. Based on the results, we concluded that the application of the C-TMS-T to the Chinese population is premature. Further validation of the C-TMS-T using another sample of participants is recommended, in particular, individuals with meditation experiences.

Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff.

The purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness-based stress reduction (MBSR) training program on a high-acuity psychiatric inpatient unit. A one-group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately post-training and at 2 months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale. The MBSR program reduced staff stress across the 2-month post-training period and increased staff mindfulness immediately following the brief training period of 8 days, and across the 2-month post-training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call-ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2 months following the training period. A brief MBSR training program offered to an interprofessional staff of a high-acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety.

Assessing Mindfulness in Multiple Contexts: a Comment on Christopher, Woodrich, and Tiernan (2014)

This paper comments on a recent study by Christopher et al. (Mindfulness 5:145–160, 2014), in which 14 Zen Buddhist priests and laypersons residing in a monastery in the Northwestern US were interviewed about the extent to which the Five Facet Mindfulness Questionnaire and the Toronto Mindfulness Scale capture the nature of mindfulness as they understand and practice it. Participants identified strengths and weaknesses of both questionnaires; findings were discussed in terms of the cultural validity of the measures. Because mindfulness is taught, practiced, and studied in both Buddhist and Western contexts, including contemporary medical, mental health, educational, and research environments, this commentary argues that at least three domains of knowledge are important in developing measures of mindfulness with broad applicability: (1) knowledge of mindfulness as described, taught, and practiced in Buddhist traditions; (2) knowledge of mindfulness as described, taught, and practiced in contemporary Western interventions and training programs; and (3) knowledge of psychological assessment, especially psychometrics and questionnaire construction. A balanced perspective that explicitly acknowledges the value for health and well-being of both Buddhist and Western psychological conceptions of mindfulness is recommended.

State Mindfulness During Meditation Predicts Enhanced Cognitive Reappraisal.

Putatively, mindfulness meditation involves generation of a state of "nonappraisal", yet, little is known about how mindfulness may influence appraisal processes. We investigated whether the state and practice of mindfulness could enhance cognitive reappraisal. Participants (N = 44; M age = 24.44, SD = 4.00, range 19 - 38, 82.2% female) were randomized to either 1) mindfulness, 2) suppression, or 3) mind-wandering induction training conditions. Cognitive reappraisal was assessed with the Emotion Regulation Questionnaire (ERQ) prior to experimental induction, and state mindfulness was assessed immediately following induction using the Toronto Mindfulness Scale (TMS). Participants practiced their assigned strategy for one week and then were reassessed with the ERQ reappraisal subscale. Participants receiving mindfulness training reported significantly higher levels of state mindfulness than participants in the thought suppression and mind wandering conditions. Although brief mindfulness training did not lead to significantly greater increases in reappraisal than the other two conditions, state mindfulness during mindfulness meditation was prospectively associated with increases in reappraisal. Path analysis revealed that the indirect effect between mindfulness training and reappraisal was significant through state mindfulness. Degree of state mindfulness achieved during the act of mindfulness meditation significantly predicted increases in reappraisal over time, suggesting that mindfulness may promote emotion regulation by enhancing cognitive reappraisal.

Teaching Mindfulness on an Inpatient Psychiatric Unit

This pilot study sought to determine if mindfulness skills could be taught to patients hospitalized with depression in a short-term, inpatient psychiatric setting. Mindfulness is the disposition to be aware of one’s current internal and external experiences while accepting them without judgment. Awareness of the breath shaped the meditation experiences used in this study. Twenty-three patients enrolled and participated in at least three mindfulness-based interventions (MBI’s). The interventions available were one-to-one meditation exercises, meditation groups, and yoga groups. Subjects completed the Philadelphia Mindfulness Scale (PHLMS) measuring mindfulness trait upon admission and at the time of discharge. The Toronto Mindfulness Scale (TMS) measuring mindfulness state was completed after each MBI. In addition, subjects completed brief written descriptions of their present-moment experience after each MBI. PHLMS scores showed a significant increase in total score and the awareness subscale. A trend analysis of TMS scores was significant for total score and both subscales. Content analysis of the present-moment statements identified five major themes in the awareness category and two in the acceptance category. This pilot study suggests that mindfulness, cultivated through meditation and yoga can be taught to, and practiced by, individuals experiencing acute psychiatric symptoms.

Using Cognitive Interviews to Assess the Cultural Validity of State and Trait Measures of Mindfulness among Zen Buddhists.

Although Western psychological mindfulness shares many common features with Buddhist mindfulness, subtle differences in the way in which it is practiced and assessed may have important implications. Therefore, the primary goal of this qualitative study was to evaluate the cultural validity of the Five Facet Mindfulness Questionnaire (FFMQ) and Toronto Mindfulness Scale (TMS) by using cognitive interviews among a sample of Buddhist clergy and laypersons to assess their perceptions of these two scales. Participants were 14 Zen Buddhists (7 laypersons, 6 Zen priests, and 1 in priest the ordination process) recruited from a monastery in the Pacific Northwestern U.S. Each participant completed a cognitive interview using the FFMQ and TMS. We developed a coding schema to identify and categorize participant responses, and then applied the final coding framework to all 14 interviews. Results revealed perceived concerns and strengths of each scale, as well as concerns regarding content deemed missing from both scales and general issues related to mindfulness self-assessment. These findings suggest that Buddhist and Western psychological conceptualizations of mindfulness may have important differences.

Treatment-specific changes in decentering following mindfulness-based cognitive therapy versus antidepressant medication or placebo for prevention of depressive relapse.

To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6-8 months of antidepressant treatment and then during an 18-month maintenance phase in which patients discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. In total, 84 patients (mean age = 44 years, 58% female) were randomized to 1 of these 3 prevention conditions. In addition to symptom variables, changes in mindfulness, rumination, and decentering were assessed during the phases of the study. Pharmacological treatment of acute depression was associated with reductions in scores for rumination and increased wider experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p < .01) and Decentering (p < .01) subscales of the Experiences Questionnaire and by the Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p < .05) and Curiosity (p < .01) predicted lower Hamilton Rating Scale for Depression scores at 6-month follow-up. An increased capacity for decentering and curiosity may be fostered during MBCT and may underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery.

Assessment of Response to Mindfulness Meditation: Meditation Breath Attention Scores in Association with Subjective Measures of State and Trait Mindfulness and Difficulty Letting Go of Depressive Cognition

How best to operationalize the mindfulness construct requires further research. In two related studies, we examined undergraduates’ self-reported ability to maintain their attention toward the process of their breathing during 10- and 15-min practices of mindful breath meditation, referred to as “Meditation Breath Attention Scores” (MBAS). MBAS were positively correlated with self-reported interest in and awareness of the breath during both 10- and 15-min meditations and negatively correlated with self-reported difficulties maintaining attention toward breathing (i.e., mind wandering) during the 15-min meditation. MBAS were not positively correlated with the Toronto Mindfulness Scale (TMS) measures of mindful “decentering” and “curiosity.” In study 2 but not study 1, MBAS were positively correlated with the five-factor mindfulness trait “Acting with Awareness.” Secondary analyses replicated an association between measures of trait mindfulness and trait difficulty letting go of depressive thoughts, although MBAS and the TMS measures were unrelated with trait difficulty letting go of depressive thoughts. Future research directions are discussed.

The Impact of Mindfulness Meditation in Promoting a Culture of Safety on an Acute Psychiatric Unit

The purpose of this study was to examine the impact of the mindfulness-based stress reduction (MBSR) program on managing work stress and improving patient outcomes. A one-group pre-/post-test design was used to measure the impact of the MBSR program. The Mental Health Professionals Stress Scale, the Sense of Self Scale, the Toronto Mindfulness Scale, and the Maslach Burnout Inventory were used. The MBSR class assisted staff in decreasing their stress levels and improve their self-care, which resulted in improved patient care. Increases in patient satisfaction and decreases in patient safety events were found.