Clinical Handbook of Mindfulness (45 page)

appear to be important. Terms used to capture these qualities include accep-

tance, openness, allowing, nonjudging, willingness, kindness, and curiosity.

Instruments for Measuring Mindfulness

Several measures of mindfulness have been developed in recent years. Most

use self-report methods to assess a general tendency to be mindful in daily

life and are based on one or more of the descriptions of mindfulness just

summarized. These instruments have shown promising psychometric char-

acteristics and have contributed to increased understanding of the nature of

mindfulness, its relationships with other psychological constructs, and the

changes that occur as individuals practice mindfulness meditation. Recently

developed mindfulness questionnaires are described in the following

paragraphs.

Freiburg Mindfulness Inventory

The Freiburg mindfulness inventory (FMI;
Buchheld, Grossman, & Walach,

2001)
is a 30-item instrument designed to assess nonjudgmental present-

moment observation and openness to negative experience in experienced

meditators. Items include, “I watch my feelings without becoming lost in

them” and “I am open to experience in the present moment.” The FMI was

developed with participants in intensive mindfulness meditation retreats and

has high internal consistency in this sample (alpha = 0. 93). From pre- to

post-retreat, mean scores increased by approximately one standard deviation.

Although factor analyses revealed that the FMI captures several components

of mindfulness, factor structure was not stable across administrations, and

the authors recommend a unidimensional interpretation.

In a subsequent study, Walach, Buchheld, Buttenmüller, Kleinknecht, and

Schmidt
(2006)
developed a 14-item form of the FMI for use in nonmedi-

tating samples. This version demonstrated adequate to good internal consis-

tency in several samples and showed differences in the expected direction

between meditators, nonmeditators, and clinical groups. Higher scores on

both versions of the FMI were related to increased private self-awareness

and self-knowledge, decreased dissociation, and lower psychological distress

in meditating and general adult samples. The authors recommend using the

longer form in samples familiar with mindfulness or Buddhist concepts and

the short form in populations without such experience.

In a sample of undergraduate students,
Leigh, Bowen, and Marlatt (2005)

found that the FMI was internally consistent and modestly related to mea-

sures of spirituality. Surprisingly, they also found that higher scores on

the FMI were associated with increased alcohol and tobacco use, possibly

because of an increased tendency to notice bodily sensations in those who

use these substances.

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

Mindful Attention Awareness Scale

The mindful attention awareness scale (MAAS;
Brown & Ryan, 2003)
is a 15-item measure assessing the general tendency to be attentive to and aware

of present-moment experiences in everyday life. Items describe being on

automatic pilot, preoccupied, and inattentive and are reverse scored, so

that higher scores represent higher levels of mindfulness. Factor analyses

revealed a single-factor structure. Example items include, “I find it difficult

to stay focused on what’s happening in the present” and “I break or spill

things because of carelessness, not paying attention, or thinking of some-

thing else.” In undergraduate and general adult samples the MAAS has demon-

strated good internal consistencies (alphas = 0. 82 and 0.87, respectively).

Evidence for convergent and discriminant validity includes positive correla-

tions with openness to experience, emotional intelligence, and well-being;

negative correlations with rumination and social anxiety; and a nonsignifi-

cant relationship to self-monitoring. Additionally, Zen Buddhist practitioners

scored significantly higher on the MAAS than matched community controls.

In recent investigations, the single-factor structure has been further val-

idated in a population of cancer outpatients
(Carlson & Brown, 2005),
as well as in a large undergraduate student sample
(MacKillop & Anderson,

2007).
However,
MacKillop and Anderson (2007)
reported that the MAAS did not discriminate between novice meditators and individuals with no prior

meditation experience. Higher scores on the MAAS have been associated

with increases in psychological mindedness
(Beitel, Ferrer, & Cecero, 2005),

decreases in mood disturbance and symptoms of stress in cancer outpatients

(Carlson & Brown, 2005),
and decreases in the tendency to experience lapses of attention
(Cheyne, Carriere, & Smilek, 2006).

Kentucky Inventory of Mindfulness Skills

The Kentucky inventory of mindfulness skills (KIMS;
Baer et al., 2004)
is based largely on the DBT conceptualization of mindfulness skills and includes

39 items measuring four facets of mindfulness: observing, describing, acting

with awareness, and nonjudgmental acceptance. The KIMS assesses the gen-

eral tendency to be mindful in daily life and does not require experience

with mediation. Items include, “I notice when my moods begin to change”

(observe); “I’m good at finding words to describe my feelings” (describe);

“When I do things, my mind wanders and I am easily distracted” (act with

awareness); and “I tell myself I shouldn’t be feeling the way I’m feeling”

(acceptance). The authors reported internal consistencies ranging from 0.76

to 0.91 for the four subscales. The four-factor structure was supported by

exploratory and confirmatory factory analyses. Evidence for convergent and

discriminant validity was provided by correlations in the expected directions

with constructs including openness to experience, emotional intelligence,

alexithymia, and experiential avoidance.

Cognitive and Affective Mindfulness Scale

The cognitive and affective mindfulness scale-Revised (CAMS-R; Feldman,

Hayes, Kumar, Greeson, & Laurenceau,
2007)
is a 12-item measure of attention, present focus, awareness, and acceptance of thoughts and feelings in

Chapter 9 Assessment of Mindfulness

157

general daily experience. These components are not measured separately

but are combined to provide a total mindfulness score. Items include, “I

try to notice my thoughts without judging them,” “It is easy for me to con-

centrate on what I am doing,” and “I am able to accept the thoughts and

feelings I have.” Internal consistency for the 12-item scale ranged from 0.74

to 0.77, and confirmatory factor analyses supported the proposed model.

The CAMS-R was positively correlated with the FMI and MAAS, well-being,

adaptive emotion regulation, cognitive flexibility, problem analysis, and plan

rehearsal and negatively correlated with symptoms of distress, worry, rumi-

nation, brooding, thought suppression, experiential avoidance, and stagnant

deliberation.

Southampton Mindfulness Questionnaire

The Southampton mindfulness questionnaire (SMQ; Chadwick, Hember,

Mead, Lilley, & Dagnan,
2005)
is a 16-item inventory assessing the degree to which individuals mindfully respond to distressing thoughts and images.

Although the SMQ is designed to capture four aspects of mindfulness (mind-

ful observation, non-aversion, nonjudgment, and letting go), the authors rec-

ommend use of a single total score. Each item begins with, “Usually when I

have distressing thoughts or images” and is followed by a statement, such

as, “I am able to just notice them without reacting” and “they take over

my mind for quite a while afterwards”. The SMQ demonstrated good inter-

nal consistency (alpha = 0. 89), was significantly correlated with the MAAS

(
r
= 0. 57), and differentiated between meditating and non-meditating indi-

viduals in expected directions. Scores on this instrument were positively

correlated with pleasant mood ratings and significantly increased following

participation in an MBSR course.

Philadelphia Mindfulness Scale

This 20-item measure
(Cardaciotto, Herbert, Forman, Moitra, & Farrow,

2007)
includes two factors that are scored separately: awareness and acceptance. Awareness refers to the ongoing monitoring of internal and exter-

nal experience (e.g., “I’m aware of thoughts I’m having when my mood

changes”). Acceptance refers to an attitude of nonjudging or openness about

experience, and refraining from attempts to avoid or escape it (e.g., “I try

to distract myself when I feel unpleasant emotions”). In several clinical and

nonclinical samples, good internal consistency was demonstrated, most cor-

relations with other constructs were significant in the expected directions,

and clinical samples generally had lower scores than nonclinical samples.

Five-Facet Mindfulness Questionnaire

Using large student samples,
Baer, Smith, Hopkins, Krietemeyer, and Toney

(2006)
studied five of the mindfulness questionnaires described earlier (all but the Philadelphia Mindfulness Scale [PHLMS], which was not available)

and found them to be internally consistent, significantly correlated with each

other, and correlated in expected directions with several other variables

predicted to be related to mindfulness, including openness to experience,

emotional intelligence, thought suppression, alexithymia, and experiential

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

avoidance. However, differences in their content and relationships with

other constructs suggested that these questionnaires might be measuring

somewhat different elements or facets of mindfulness. The MAAS appeared

to emphasize an aspect of mindfulness that is inversely associated with

dissociation and absent mindedness, whereas the SMQ was most strongly

associated (negatively) with experiential avoidance and difficulties in emo-

tion regulation. To examine facets of mindfulness systematically,
Baer et al.

(2006)
combined responses to all five of these questionnaires into a single data set and conducted exploratory factor analysis to examine underly-

ing dimensions. This analysis allowed items from different instruments to

combine to form factors, yielding an empirical integration of these indepen-

dent attempts to operationalize mindfulness. Findings suggested a five-factor

solution.
Observing
includes noticing or attending to internal and external

stimuli, such as sensations, emotions, cognitions, smells, sounds, and sights.

Describing
refers to labeling observed experiences with words.
Acting with

awareness
includes attending to the activities of the moment and can be con-

trasted with automatic pilot, or behaving mechanically, without awareness of

one’s actions.
Nonjudging of inner experience
refers to taking a nonevalua-

tive stance toward cognitions and emotions.
Nonreactivity to inner experi-

ence
is the tendency to allow thoughts and feelings to come and go, without

getting carried away by them or caught up in them. The five-facet mindful-

ness questionnaire (FFMQ), which contains 39 items, was created by select-

ing the seven or eight items with the highest loadings on their respective

factors and low loadings on all other factors. The five-facet scales demon-

strated adequate to excellent internal consistency (alphas ranging from 0.75

to 0.91), and relationships between the facet scales and other variables were

consistent with predictions in most cases
(Baer et al., 2006).

Recent findings with the FFMQ support the utility of measuring facets of

mindfulness separately and help to clarify the skills that are cultivated by the

practice of mindfulness meditation.
Baer et al. (2007)
administered the FFMQ

in a sample of experienced meditators and several nonmeditating compari-

son samples. Scores on four of the facets (all but
acting with awareness
)

were significantly correlated with extent of meditation experience and med-

itators scored higher than nonmeditators. In the group of experienced med-

itators, all facets were significantly negatively correlated with psychological

symptoms and positively correlated with psychological well-being. Several

of the facets demonstrated incremental validity over the others in predicting

well-being and contributed to the significant mediation of the relationship

between meditation experience and well-being. These results support the

common assumption that meditation cultivates mindfulness skills, which in

turn facilitate psychological health. Findings also suggest that consideration

of multiple facets of mindfulness is helpful in understanding the relationship

between mindfulness and psychological adjustment.

In samples of experienced meditators and demographically similar non-

meditators,
Lykins and Baer (in press)
examined relationships between meditation experience and several proposed mechanisms by which mindfulness