Clinical Handbook of Mindfulness (44 page)

sities Press.

Kabat-Zinn, J., (1982). An autpatient program in behavioural medicine for chronic

patients based on the practice of mindfulness meditation: Theoretical considera-

tions and preliminary results.
General Hospital Psychiatry, 4
, 33–47.

Kabat-Zinn, J., (1990).
Full catastrophe living: Using the wisdom of your body and

mind to face stress, pain and illness
. New York: Dell publishing.

Kabat-Zinn, J. (2005).
Coming to our senses
. London: Piatkus Books Ltd.

Kernberg, O., (1975).
Borderline conditions and phatological narcissism
.

New York: Jason Aronson.

Kohut, H., (1971).
The analysis of self
. New York: International Universities Press.

Kohut, H., (1977).
The restoration of the self
. New York: International Universi-

ties Press.

Komito, D. R., (1984). Tibetan Buddhism and psychotherapy: Further conversations

with the Dalai Lama.
The Journal of Transpersonal Psychology, 16
(1), 1–24.

Laing, R. (1969).
The divided self
. New York: Pantheon.

Leichsenring, F. (2004). Quality of depressive experiences in borderline personality

disorders: Differences between patients with borderline personality disorder and

patients with higher levels of personality organization.
Bulletin of the Menninger

Clinic, 68
(1), 9–22.

Linehan, M., (1993).
Cognitive-behavioral treatment of borderline personality dis-

order
. New York: The Guilford Press.

Maureta Reyes, M. (2007). In Vacio esistencial, un mal contemporaneo. Mejia, R.

www.amapsi.org

May, R. (1950).
The meaning of anxiety
. New York: Simon and Schuster.

May, R. (1953).
Man’s search for himself
. New York: Signet Norton.

Medweth, M.
HYPERLINK “http://www.jefallbright.net/node/2901” Becoming

Nobody
.

Department

of

Psychology.

Simon

Fraser

University.

Web

site:

http://www.purifymind.com/BecomingNobody.htm

Millon, T. (1996).
Disorders of personality. DSM-IV
and beyond., New York: John

Wiley & Sons.

Millon, T. (1999).
Personality-Guided therapy
. New York: John Wiley & Sons.

Modell, A. H., (1984).
Psychoanalysis in a new context
. New York: International

University Press.

Pascal, B. (1965).
Pensees
, Paris: Armand Colin.

Pazzagli, A., & e Monti, M. R., (2000). Dysphoria and aloneness in borderline person-

ality disorder.
Psychopathology
,
33
(4), 220–226 July–August.

Rawson, P., (1991).
Sacred tibet
. London: Thames and Hudson.

Chapter 8 Mindfulness and Feelings of Emptiness

151

Rogers, J. H., Widiger, T. A., & Krupp, A., (1995). Aspects of depression associated

with borderline personality disorder.
American Journal of Psychiatry
,
152
(2),

268–270 February.

Sanavio, E., (1991).
Psicoterapia Cognitiva e Comportamentale
. Roma: La Nuova

Italia Scientifica.

Segal, Z. V., Williams, J. M., & y Teasdale, J. D., (2002).
Mindfulness-based cogni-

tive therapy for depression. A new approach to preventing relapse
. New York:

Guilford.

Spitzer, R. L., (1975). Crossing the border into borderline personality and border-

line schizophrenia. The development criteria.
Archives of General Psychiatry, 36
,

17–24

Sunyata
(2007). http://en.wikipedia.org/wiki/Shunyata

Teasdale, J. D., (2004)
Minfulness and the third wave of cognitive-behavioural ther-

apies
. Keynote address presented at the 34th Annual Conference of the EABCT,

Manchester, England.

Trobe-Krishnananda, T. (1996).
Face to face with fear
. Verlag: Koregaon Publications

Trobe-Krishnananda, T. (1999).
Stepping out of fear
. Verlag: Koregaon Publications.

Wallance, A. B., & e Shapiro, S. L., (2006) Mental balance and well-being: Building

bridges between Buddhism and western psychology.
American Psychologist, 61
,

690–701.

Wells, A., (1997).
Cognitive therapy of anxiety disorders
. Chicester: Wiley.

Wells, A., (2000).
Emotional disorders and metacognition: Innovative cognitive

therapy
. Chicester: Wiley.

Wells, A., (2002). Gad, metacognition and mindfulness: An information processing

analysis.
Clinical Psychology: Science and Practice, 9
, 95–100.

Wells, A., (2006). Detached mindfulness in cognitive therapy: a metacognitive analysis

and ten techniques.
Journal of Rational-Emotive and Cognitive-Behavior Ther-

apy, 3
, 337–335.

Westen, D., Moses, M. J., Silk, K. R., Lohr, N. E., Cohen, R., & Segal, H. (1992). Qual-

ity of depressive experiences in borderline personality disorder and major depres-

sion: When depression is not just depression.
Journal of Personality Disorders, 6
,

382–393.

Winnicott, D. W., (1965a).
The maturaional processes and the facilitating environ-

ment
. New York: IUP.

Winnicott, D. W., (1965b).
The family and individual development
., London: Tavis-

tock Publications.

Young, J. E., (1987). Schema-focused cognitive therapy for personality disorders.

International cognitive therapy newsletter, 4, 5
, 13–14

Young, J. E., & Flanagan, C. (1998). Schema-focused therapy for Narcissistic Patients,

In E. F. Ronninggstam (Ed.),
Disorders of narcissism: Diagnostic, clinical, and

empirical implications
. New York: American Psychiatric Press.

Young, J. E., Klosko, J. S., & Weishaar, M., (2003).
Schema therapy: A practitioner’s

guide
. New York: Guilford Publications.

9

Assessment of Mindfulness

Ruth A. Baer, Erin Walsh, and Emily L. B. Lykins

Mindfulness can be cultivated by paying attention in a specific

way, that is, in the present moment, and as non-reactively, non-

judgmentally and openheartedly as possible.

Kabat-Zinn (2005,
p. 108)

Mindfulness-based interventions have been developed for a wide range of

problems, disorders, and populations and are increasingly available in a vari-

ety of settings. Empirically supported interventions that are based on or

incorporate mindfulness training include acceptance and commitment ther-

apy (ACT;
Hayes, Strosahl, & Wilson, 1999),
dialectical behavior therapy (DBT;
Linehan, 1993),
mindfulness-based cognitive therapy (MBCT; Segal,

Williams, & Teasdale,
2002),
and mindfulness-based stress reduction (MBSR;

Kabat-Zinn, 1982, 1990).
Variations on these approaches, including integration of mindfulness training into individual psychotherapy from diverse per-

spectives, also have been described
(Germer, Siegel, & Fulton, 2005).
As the empirical evidence for the efficacy of these interventions continues to

grow, the importance of investigating the mechanisms or processes by which

they lead to beneficial outcomes is increasingly recognized
(Bishop et al.,

2004;
Shapiro, Carlson, Astin, & Freedman, 2006).
Addressing this question requires psychometrically sound measures of mindfulness (Baer, Smith, &

Allen,
2004;
Brown & Ryan, 2004; Dimidjian & Linehan, 2003).
Without such measures it is impossible to determine whether the practice of mindfulness leads to increased levels of mindfulness and whether these changes

are responsible for the improvements in psychological functioning that are

often observed.

The development of tools for assessing mindfulness requires clarity about

its definition. According to
Clark and Watson (1995),
a sound measure must be based on “a precise and detailed conception of the target construct”

(p. 310). Although the current literature includes many descriptions of mind-

fulness, several authors have noted that mindfulness is a subtle and some-

what elusive construct and that defining it in concrete terms is difficult

(Block-Lerner, Salters-Pednault, & Tull, 2005;
Brown & Ryan, 2004).
Compounding the difficulty is the necessity of understanding closely related con-

structs such as acceptance and decentering. These are sometimes described

as components or elements of mindfulness
(Block-Lerner et al., 2005;
Dimidjian & Linehan,
2003),
whereas others argue that they are better understood as outcomes of practicing mindfulness
(Bishop et al., 2004)
or as skills that aid in fostering mindfulness (Brown, Ryan, & Creswell, in press). This

chapter will provide an overview of current definitions and descriptions

153

154

Ruth A. Baer, Erin Walsh, and Emily L. B. Lykins

of mindfulness, instruments that have been developed to measure it, and

findings based on the use of these instruments. Assessment of acceptance

and decentering will be addressed, and future directions for research on the

assessment of mindfulness will be discussed.

Definitions and Descriptions of Mindfulness

Perhaps the most commonly cited definition is provided by
Kabat-Zinn

(1994),
who describes mindfulness as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally.” Several other definitions are similar. For example,
Marlatt and Kristeller (1999)
describe mindfulness as “bringing one’s complete attention to the present experience on

a moment-to-moment basis” (p. 68), and
Brown and Ryan (2003)
define it

as “the state of being attentive to and aware of what is taking place in the

present” (p. 822). Other descriptions are somewhat more detailed. Accord-

ing to
Bishop et al. (2004),
mindfulness is “a process of regulating attention in order to bring a quality of non-elaborative awareness to current experience

and a quality of relating to one’s experience within an orientation of curiosity,

experiential openness, and acceptance” (p. 234).
Segal et al. (2002)
note that

“
. . .
in mindfulness practice, the focus of a person’s attention is opened to

admit whatever enters experience, while at the same time, a stance of kindly

curiosity allows the person to investigate whatever appears, without falling

prey to automatic judgments or reactivity” (p. 322–323). These authors also

note that mindfulness can be contrasted with behaving mechanically, with-

out awareness of one’s actions, in a manner often called
automatic pilot
.

Kabat-Zinn (2003)
states that “mindfulness includes an affectionate, compassionate quality within the attending, a sense of openhearted friendly pres-

ence and interest” (p. 145). Similarly,
Marlatt & Kristeller (1999)
suggest that mindfulness involves observing one’s experiences “with an attitude of acceptance and loving kindness” (p. 70).

Commonly used instructions for teaching mindfulness are consistent with

these definitions and descriptions. Participants in mindfulness training are

often encouraged to focus their attention on particular types of stimuli that

are observable in the present moment, such as sounds that can be heard in

the environment or the movements and sensations of breathing. If thoughts,

emotional states, urges, or other experiences arise, participants are encour-

aged to observe them closely. Brief, covert labeling of observed experiences,

using short words or phrases, is often encouraged. For example, partici-

pants might silently say “sadness,” “thinking,” “aching,” “urge,” or “sound” as

they observe internal or external phenomena. Participants are typically asked

to bring a stance of acceptance, willingness, allowing, openness, curios-

ity, kindness, and friendliness to all observed experiences, and to refrain

from efforts to evaluate, judge, change, or terminate them, even if they are

unpleasant. In DBT
(Linehan, 1993),
mindfulness has been operationalized as a set of interrelated skills; three related to what one does while practicing mindfulness, and three related to how one does it. The “what” skills

include
observing
(noticing or attending to) current experience,
describ-

ing
(noting or labeling observed experiences with words), and
participat-

ing
(focusing full attention on the current activity). The “how” skills include

being
nonjudgmental
(accepting, allowing, or refraining from evaluation),

Chapter 9 Assessment of Mindfulness

155

being
one-mindful
(with undivided attention), and being
effective
(using

skillful means).

This collection of definitions, descriptions, and instructions for teaching

mindfulness suggests that mindfulness may be usefully conceptualized as

a multifaceted construct that includes attending to (observing or noticing)

present moment experiences, labeling them with words, and acting with

awareness or avoiding automatic pilot. Particular qualities of attention also