What are the Active Ingredients of

Mindfulness-based Intervention

Mindfulness-based interventions typically comprise numerous elements, including

some or all of the following: guided mindfulness exercises, guided loving-kindness
and compassion meditation exercises, group discussion, psycho-education
(sometimes in the style of a university lecture), yoga, one-to-one discussion with the
programme facilitator, a CD of guided meditations to encourage at-home practice,
and a full or half-day silent group retreat. Given that each of the above techniques
arguably have therapeutic utility in their own right, ascertaining why MBIs are
effective is problematic because they have numerous active ingredients.
Not controlling for other active ingredients is a common limitation of MBI
intervention studies. Indeed, although scientific evidence demonstrates that certain
MBIs are equally or more effective than other treatments for improving specific
health conditions, it is currently unclear whether it is mindfulness, or mindfulness in
combination with other therapeutic techniques, that results in health benefits. One
way to overcome this methodological limitation is to employ a purpose-designed
active control condition. This is a control intervention that mirrors the main
intervention in terms of its design, but does not include any mindfulness techniques.
By conducting a randomised controlled trial that compares the effectiveness of an
MBI against a suitably formulated active control intervention, we can determine that
superior outcomes in the MBI versus control group are caused by mindfulness.
It could be argued that it doesnt matter whether it is specifically mindfulness
or other intervention components that make MBIs effective. If we are only
interested in treatment outcomes and adhere to a what works approach to
alleviating illness symptoms, then establishing which intervention components are
most effective becomes less important. However, from the point of view of
advancing scientific understanding of how the human mind reacts to given

psychotherapeutic techniques, it is useful to establish which ingredients are most

active within a given intervention. Such knowledge can also help to inform the
development of more effective and therapeutically streamlined MBIs.
When designing an active control intervention for MBI efficacy studies, in
addition to matching the design of the target and control interventions (i.e., minus
the inclusion of mindfulness techniques), it is also important to match the
competency of the instructor or instructors delivering the two interventions. For
example, a number of meditation intervention studies employing an active control
condition have used an experienced clinician and meditation teacher to deliver the
MBI, whilst leaving a relatively inexperienced student to administer the control
intervention. Clearly, such an approach can introduce bias and weaken the strength
of the evidence from MBI studies.
In order to overcome the above methodological limitation, in a recent
randomised controlled trial that we conducted, the study was designed such that the
same instructor delivered the MBI and comparison intervention. To control for
potential bias on the part of the instructor, participants in each intervention
condition were asked to rate the instructors levels of enthusiasm and preparation.
Statistical tests were then performed to determine if there were significant
differences between how participants from the intervention and control group rated
the instructors performance.
We decided to control for an instructor effect because in our opinion, the
mindfulness instructor is one of the most active ingredients in MBIs. Part of our
research has involved the development and empirical investigation of a secondgeneration of MBI. Second-generation MBIs (such as Meditation Awareness
Training) are designed slightly differently compared to first-generation MBIs (such
as Mindfulness-based Stress Reduction or Mindfulness-based Cognitive Therapy).
More specifically, second generation MBIs are overtly spiritual in nature and teach a
greater range of meditative techniques. Given that second-generation MBIs
comprise different design elements compared to first-generation MBIs, it is
reasonable to assume that these two types of MBIs will result in different outcomes.
However, despite the design differences between first- and second-generation MBIs,
it is our view that if a mindfulness teacher with authentic spiritual realisation was to
administer a first-generation MBI, the outcomes would be very similar to them
administering a second-generation MBI.
In other words, if the mindfulness teacher is genuinely rooted in the present
moment, the specific design of the MBI becomes less important. As we discussed in

our post on The Four Types of Psychologist, we would argue that the same principle
applies to the majority of psychological therapies. If the clinician knows their own
mind, has genuine compassion for the client, and is skilled in helping the client
understand their problems, then the choice of therapy becomes less important.
Although preliminary findings (including from some of our own clinical case
studies and qualitative studies) support the notion that the mindfulness teacher is
one of the (if not the) most important ingredients of MBIs, there is clearly a need
for further research investigating how the instructor influences outcomes. However,
in the absence of extensive empirical investigation into this subject, we hypothesise
that what participants of MBIs need most (and therefore respond best to), is the
unconditional love and spiritual wisdom of a teacher who is without a personal
agenda, and whose mind is saturated with meditative awareness.

Ven. Edo Shonin and Ven. William Van Gordon

Further Reading
Baer, R., Smith, G., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using selfreport assessment methods to explore facets of mindfulness. Assessment, 13, 2745.
Chiesa, A. (2013). The difficulty of defining mindfulness: Current thought and
critical issues. Mindfulness, 4, 255-268.
Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the
same? Journal of Clinical Psychology, 67, 404-424.
MacCoon, D., Imel, Z., Rosenkranz, M., Sheftel, J., Weng, H., Sullivan, J., . . . Lutz,
A. (2012). The validation of an active control intervention for Mindfulness
Based Stress Reduction (MBSR). Behavior Research and Therapy, 50, 3-12.
Shonin, E., Van Gordon, W., Dunn, T., Singh, N. N., & Griffiths, M. D. (2014).
Meditation Awareness Training for work-related wellbeing and job
performance: A randomised controlled trial. International Journal of Mental
Health and Addiction, 12, 806-823.
Van Gordon, W., Shonin, E., & Griffiths, M. (2015a). Towards a second-generation
of mindfulness-based interventions. Australia and New Zealand Journal of
Psychiatry, 49, 591-591.