Mindfulness: process, skill or strategy? A behavioral-analytic and functional-contextualistic analysis

Abstract

Mindfulness has been widely disseminated in clinical psychology in recent years, due to the positive effects on treating several psychological issues in diverse population. Nonetheless, empirical research and theoretical reviews show three different meanings of mindfulness within behavioral approaches: as a process, as skill, and as a strategy. Discrepancies about mindfulness definitions have brought ambiguity to what and how this phenomenon is studied. A conceptual analysis of mindfulness according to behavioral-analytic and functional-contextualistic philosophical traditions is presented. Finally, it was discussed the relevance of employing a precise and consensual definition of mindfulness to develop a coordinated research agenda in this field.

Keywords:
mindfulness; behaviorism; functional-contextualism; clinical psychology; interventions

Resumen

Los efectos positivos del mindfulness en el tratamiento de múltiples problemas psicológicos en diversas poblaciones han popularizado su uso dentro de la psicología clínica en los últimos años. No obstante, las investigaciones empíricas y revisiones teóricas sobre el mindfulness muestran tres usos diferentes del mindfulness dentro de las aproximaciones conductuales: como proceso, como habilidad y como estrategia. Las discrepancias en las definiciones de mindfulness han generado ambigüedad con respecto a qué y cómo se investiga este fenómeno. En este trabajo se realizó un análisis conceptual de las definiciones del mindfulness de acuerdo con los supuestos filosóficos analíticos-conductuales y contextualistas-funcionales. Finalmente, se discutió la importancia de contar con una definición precisa y unánime con el fin de desarrollar una agenda coordinada de investigación en esse campo.

Palabras clave:
mindfulness; conductismo; contextualismo-funcional; psicología clínica; intervención

Résumé

Les effets positifs du mindfulness dans le traitement de plusieurs problèmes psychologiques dans différentes populations ont encouragé la psychologie clinique à l’utiliser au cours des dernières années. Cependant, la recherche théorique et empirique sur les examens de pleine conscience montrent trois utilisations différentes de l’attention dans les approches comportementales: comme un processus, comme une compétance et en tant que stratégie. Les divergences dans les définitions de la pleine conscience ont créé une ambiguïté quant à pourquoi et comment ce phénomène est étudié. Cet article est une analyse conceptuelle de la pleine conscience ayant comme paramètres philosophiques l’analyse du comportement et le contextualisme fonctionnel. La discussion finale tourne autour de l’importance d’avoir une définition précise et unanime en vue d’élaborer un programme coordonné de recherche dans ce domaine.

Mots-clés:
mindfulness; béhaviorisme; contextualisme-fonctionnel; psychologie clinique; intervention

Resumo

Os efeitos positivos do mindfulness no tratamento de vários problemas psicológicos em diferentes populações incentivaram a psicologia clínica a utilizá-lo nos últimos anos. No entanto, pesquisas empíricas e revisões teóricas sobre o mindfulness mostraram três usos diferentes desse termo segundo perspectivas comportamentais: como processo, como habilidade e como estratégia. As discrepâncias nas definições do mindfulness geraram ambiguidade em relação àquilo que é pesquisado e como é pesquisado. Neste texto, realizou-se uma análise conceitual das definições do mindfulness tendo como bases filosóficas a análise do comportamento e o contextualismo funcional. Por último, discutiu-se a importância de ter uma definição precisa e unânime com o objetivo de desenvolver uma agenda coordenada de pesquisa nesse campo.

Palavras-chave:
mindfulness; comportamentalismo; contextualismo-funcional; psicologia clínica; intervenção

Clinical psychology has shown a growing interest in mindfulness, given the positive effect of this intervention in different types of disorders and psychological problems, such as: mood disorder, binge eating disorder, anxiety and stress (Arch & Craske, 2005; Baer, 2003; Brito, 2011; Caycedo & Novoa, 2010; Franco, 2009; Formana et al., 2007; Gethin, 2011; Kabat-Zinn, 2003; Langer, 1989; Marlatt & Gordon, 1985; Sahagún & Salgado, 2013; Walsh, 2008). This has led to study the critical aspects of mindfulness to explain it and establish the procedures involved in its development.

The term “mindfulness” was first translated by Thomas William Rhys Davids in 1881, derived from the Buddhist term “sati” or “smrti”, from this, several authors tried to define it, based on the readings and interpretations of Buddhist texts (Gethin, 2011). For Buddhist philosophy the practice of mindfulness promotes lasting happiness (Elkman, Davidson, Richard, & Wallace, 2005) and reveals the true nature of existence in which there is no permanent and immutable self, in other words, that individuals are ongoing changing (Olendzki, 2010).

In psychology the practice of mindfulness attracted the interest of researchers in the middle of the 70s, when they began to compare the the effects of mindfulness to mindless behaviors (not be present) in social interactions (Langer & Moldoveanu, 2000). Given the effects that were observed in people who practice mindfulness, this started to be applied in health care (psychology and medicine), independently of the religious and cultural traditions of its Eastern and buddhist origins (Baer, 2003), as an alternative treatment for people who did not respond or felt unsatisfied with traditional interventions related to medical conditions such as: chronic pain (fibromyalgia and cancer), acute pain, cardiovascular disease, diabetes, hypertension, headaches, chronic fatigue, skin problems and sleep disturbances (Moñivas, García-Diex, & García-de-Silva, 2012). Its implementation had important effects in symptoms reduction, becoming an intervention that provided quick and effective responses, as evidenced by research published in recent years. Mindfulness utility was observed and it led to some questions about (a) what is the impact of this practice on the people’s behavior, (b) what kind of changes were directly related to the practice, and (c) how to measure the change in skills of mindfulness through training (Walsh, 2008).

Specifically in cognitive psychology it is been developed a long line of research in order to understand the mechanisms that underline the practices of mindfullness. One of the pioneers within this perspective is Jon Kabat-Zinn, who defines the “process of give attention in a particular way; with a purpose, in the present moment, and without judging” (Kabat-Zinn, 1994, p. 4). Baer (2003) updated the definition of Kabat-Zinn, pointing: “mindfulness is the nonjudgmental observation of the ongoing stream of internal and external stimuli as they arise” (p. 125). Subsequently, Bishop et al. (2004) integrated elements related to self-observation as a fundamental aspect. According to these authors, mindfulness refers to the quality of self-focusing attention, self-observing the own experience openly and accepting it as it is. Although similar, the differences between defining elements of this object of study, speaking about mindfulness, has led to difficulties in the coherence of research program of this field within the cognitive psychology (Bishop et al., 2004). Especially to identify the explicit aspects of the effects of mindfulness as a central element of this kind of approach.

As an alternative to cognitive approaches, which have been centered in establishing the mechanisms that underlie the mindfulness based on a mechanistic metaphor, contextualistic approaches have tried to explain how the practice of mindfulness allows individuals to interact in a more flexible and functional way with the environment. Thus, these approximations assume that the act is explained only in context, and its fractionation in tiny parts would produce a biased view of the explanatory elements (Hayes, Hayes, & Reese, 1988; Pepper, 1942)

Although the contextualist spirit has tried to be the fundamental axis to explain the mindfulness in the functional contextual psychology, the current literature about this subject raises problems related the attributes given to mindfulness that overlap with categories of different nature, producing categorical errors in this conceptualization (Caycedo & Novoa, 2010; García, 2014; Hayes & Wilson, 2003). This categorical errors are defined by Ryle (1937-1938) as problems that occur in the use of language when recourse is made to various predicates that are not coherent to define a term. These errors are recurrent in different studies about mindfulness, in which authors often mention that mindfulness is a process or skill, but a further review of the development of their research evidence that mindfulness was utilized as a strategy for producing therapeutic change (Barragán, Lewis, & Palacio, 2007; Erisman & Roemer, 2010; Franco, 2010; Grepmair et al., 2007; Martín-Asuero & García de la Banda, 2007; Medeiros & Pulido, 2011). These disagreements expose the importance of and analyzing the different approaches that have worked on the term mindfulness, specifically from behavior analysis, given the interest of this psychological perspective in the use of parsimonious terms.

The present article addressed the meanings of mindfulness in functional contextual approaches, in which it has been defined as: process, skill and strategy. As key words in the search of literature were included: mindfulness, conceptualization, theory, behavior analysis, and functional contextualism. The terms cognition and neurosciences were exclude.

In order to provide a clear context about the conceptualization of mindfulness, texts about philosophy of behavioral science and philosophy of mind were reviewed, allowing arguing the difficulties in some of the definitions provided in contextualism perspectives. Finally, this article aims to expose the benefits and difficulties in the theoretical conceptualizations of mindfulness and thus support a relevant and coherent exercise of behavioral psychology in this area.

Mindfulness as a process

The term process originates from Latin processus that means to advance (Real Academia Española, 2001). According to the behavior analysis, processes are called those changes (continuous and progressive) in the behavior that occur given the influence of contextual events on the responses of organisms (Catania, 2007).

Within the Acceptance and Commitment Therapy (ACT), therapy developed from a functional contextualist approach, mindfulness is defined as a process that is an interface of the following four processes: contact with the present moment, acceptance, defusion and self. These processes have defining characteristics of the change, for example, the contact with the present moment refers to the ability to attend the moment to moment of the events and it is the most recognizable psychological flexibility process involved in mindfulness (Wilson, Bordieri, & Whiteman, 2012). From this perspective, mindfulness as a process is characterized to attend the moment to moment of the private events, being willing to experience them as they occur, noticing or recognizing verbal rules without reacting to them, and relating what happens to the perspective of oneself.

The previous analysis of mindfulness as a process presents ambiguities that make difficult to explain it, in terms of the contextual factors that influence its change (according to the philosophical assumptions of the contextualistic science). Therefore, it is unclear how mindfulness acts as a separated or independent process that is controlled by the environment, because as pointed by Wilson, Bordieri and Whiteman (2012) this is in interaction with the other processes (present moment, acceptance, defusion and self). Comparing mindfulness as a process described by Wilson and Luciano (2002) and Wilson, Bordieri and Whiteman (2012) with the definition of the process from behavior analysis provided by Catania (2007), it is evident that to explain the manipulation of the environment is used the ACT (as intervention), which could help the development of mindfulness as a process. Nevertheless, ACT developers indicated that this therapy is made-up by the same processes that control the mindfulness (Hayes, Strosahl, & Wilson, 2012), which leads to a tautological cycle in which it is difficult to identify the contextual events that influence the processes embedded in this conceptualization.

It is important to clarify that, in the recent behavioral literature there is no other definition of mindfulness as a process that allows contrasting the definition provided by Wilson, Bordieri and Whiteman (2012) to other proposals.

Mindfulness as a skill

The word ability (skill) comes from Latin habere which means to have (Real Academia Española, 2001). From this term is derived habilis, related to manageable things, something well adjusted, accommodated, in others words, manipulated for something. Abilities always refer to what is done effectively” (Ribes, 2006, p. 20). The same author points out that doing effectively is operationalized as the adjustment of individual responses that are performed to produce an effect or result on a medium or body.

Regarding to the skill category, Linehan (1993) defines mindfulness as a repertoire of skills of «what» and «how». The first one is composed by the repertoires related to observe, describe and participate, consisting in the observation characterized by attending to events, emotions and other behavioral responses, without trying to end them when they hurt or extend them when they are pleasant. In other words, observe skills seek to experience the events with awareness at the moment, rather than just living the situation or trying to end the emotion. Describing, or speaking about the events and responses in words, refers to the skill to take emotions and thoughts non-literally, that is, in relation to their physical and not conventional characteristics. Finally, the skill to participate consists of realize all activities of the present moment without disconnecting from the current events and interactions in the environment.

The skills related to “how” involve taking a non-critical stance, focusing on one thing, at the moment and being effective. Taking a non-critical stance refers to the description of events in terms of their formal properties (non-arbitrary) (Chaparro-Moreno & Medina-Arboleda, 2013; Hayes & Quiñones, 2005). To focus on a thing at the moment is to attend to a stimulus or to do a single activity at a given moment, without engaging in another behavior; and be effective refers to behaving according to established criteria, but which are not valuative (Linehan, 1993).

It is important to point out that these skills are aimed to the thoughts and feelings be seen as transient events, in such a way that the person interacts to everything that is happening around at that moment and that does not focus only on the own answers (Ramos, Enríquez, & Recondo, 2012).

Comparing mindfulness as a skill defined by Linehan (1993) with the skill definition described by Ribes (2006) it is possible to perceive that are coherent, given that Linehan mentions a series of very specific responses or specific behaviors that allow people to interact with the environment effectively.

Mindfulness as a strategy

The word strategy comes from Latin strategĭa referring to driving or guiding (Real Academia Española, 2001). Punctually for behavior analysis is a procedure in which a series of steps are followed to manipulate an independent variable, also called intervention, treatment or experimental variable (Cooper, Heron, & Heward, 2007).

In the case of mindfulness strategies, they consist of interventions based on the practice of meditation exercises and experiential exercises (Baer, 2003). This intervention does not constitute a single protocol, but are activities that are selected according to the goal of the therapist or researcher involving following guided instructions and personal practice (Mace, 2007). The mindfulness purpose is to design exercises that encourage people to attend to the internal experiences that occur at any moment, such as: body sensations, thoughts and emotions. Others encourage paying attention to aspects of the environment, like images and sounds (Baer, 2003).

Whatever the objective, it is recommended that the therapists have practiced mindfulness ahead so that clients training and experience might be facilitated (Deatherage, 1975); also, the instructions must be adjusted to the objectives of each exercise.

Within empirical evidence, some studies have used mindfulness as a strategy for the treatment of different problems such as mood, binge eating, anxiety and stress disorders (Baer, 2003; Brito, 2011; Franco, 2009; Formana et al., 2007; Gethin, 2011; Kabat-Zinn, 2003; Walsh, 2008), addictive behaviors (Langer, 1989; Marlatt & Gordon, 1985), emotional regulation (Arch & Craske, 2005; Caycedo & Novoa, 2010), gender violence (Sahagún & Salgado, 2013), so forth.

The comparison of the definition of mindfulness as a strategy by Baer (2003) and Mace (2007) with the definition of strategy described by Cooper, Heron and Heward (2007) evidences the correspondence among these authors conceptualizations, explaining that mindfulness as an intervention is composed of a series of steps adjusted by the goals of the therapist, in order to generate changes in dependent variables.

Discussion

The present article aimed to show the different meanings of mindfulness in the literature available within the behavioral perspective as a synthesis. This review shows how mindfulness has been used differently among researchers, promoting ambiguity over the term, resulting in a poor development of lines of research that complement each other in favor of the growth of a coherent scientific body at a conceptual and practical level. In this regard, some conclusions and recommendations are presented regarding the use of the word mindfulness that could be useful to reach a consensus within this psychological perspective; as evidenced in the corpus of this review, after a systematic search in different databases (Scholar Google, PsyINFO, Elsevier, EBSCO). The articles in this area show inconsistencies between the operationalization of the term and its practical use. In many cases authors define mindfulness as a skill or a process, but, through the research, it is observed that it is used as an intervention strategy. Based on Ryle’s (2005) philosophy of mind, the multiple definitions of mindfulness might produce considered a categorial error which leads to logical and grammatical confusions in psychological research. These mistakes are being made by basic and applied psychologists (as can be seen in the sections above) leading to wrong conceptual and practical conclusions (Moya, 2004; Ryle, 1937-1938, 2005).

Based on the review and operationalization used of the different predicates of mindfulness as process, skill and strategy, it is recommended to use the terms skill and strategy, in future research, due to these both have shown a coherent conceptualization from their semiological roots. Specifically, it is proposed to use distinctive words for each of them, “awareness skills” and “mindfulness strategies”, with the aim of correcting this categorical errors and promoting a research corpus clearly defined mutually exclusive.

On the one hand, awareness skills would fit into the definition of awareness given in behavior analysis, being consistent with the basic conceptual framework; because this is defined as the ability to verbally self-describe what the individual does, whether explicitly or not, implying the acquisition of behavioral repertoires characterized by the discrimination of the own behavior. This involves tacting on private events and relating them to different verbal operant historically established which can be learned from various verbal communities (Catania, 2007; Delprato & Midgley, 1992; Machado, 1997).

On the other hand, the term of mindfulness as strategies is adjusted to the literature in general, not only derived from the behavioral perspective, and it is closely related to the use it has had since its origin, as the practice of specific exercises.

About mindfulness as a process, after the analysis of its meaning, it is recommended to reduce its use and even to stop using it; as it has been pointed out, the use of mindfulness as process has thwarted the understanding and study of these topic, since due to when comparing the definition of mindfulness as process with the definition of skills provided by the literature, as the adjustment of the individuals response to produce an effect or a result on a medium or a body (Ribes, 2006), it is found that the four processes of the hexaflex (present moment, acceptance, defusion and self) mentioned by Wilson, Bordieri and Whiteman (2012) can be adjusted in this category as a dependent variable that is part of a behavioral repertoire acquired from the strategies utilized, particularly those used in ACT and not to a process definition.

Finally, although many of the studies developed in the field of mindfulness have shown the importance of increasing the research in this area, given the positive effects that have been observed at the practical level, conceptual definitions have been overlapped by studies. So the analysis in this article provided a pathway which can help researchers of this field to adjust conceptual aspects and delimit the variables of interest without redounding their finding so that the explanatory factors of mindfulness (as a strategy), which produce therapeutic change, could be determined.

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Publication Dates

• Publication in this collection
  May-Aug 2017

History

• Received
  22 Mar 2016
• Reviewed
  14 July 2016
• Accepted
  11 Sept 2016