A mind you can count on: validating breath counting as a behavioral measure of mindfulness

METHODS ARTICLE published: 24 October 2014 doi: 10.3389/fpsyg.2014.01202 A mind you can count on: validating breath counting as a behavioral measure of mindfulness Daniel B. Levinson*, Eli L. Stoll, Sonam D. Kindy, Hillary L. Merry and Richard J. Davidson* Waisman Laboratory for Brain Imaging and Behavior, Center for Investigating Healthy Minds, Psychology Department, University of Wisconsin–Madison, Madison, WI, USA Edited by: Heather Berlin, Icahn School of Medicine at Mount Sinai, USA Reviewed by: Mattie Tops, VU University Amsterdam, Netherlands Zoran Josipovic, New York University, USA *Correspondence: Daniel B. Levinson and Richard J. Davidson, Waisman Laboratory for Brain Imaging and Behavior, Center for Investigating Healthy Minds, Psychology Department, University of Wisconsin–Madison, 1500 Highland Avenue, Madison, WI 53705, USA e-mail: danlevinson@alumni. stanford.edu; Mindfulness practice of present moment awareness promises many benefits, but has eluded rigorous behavioral measurement. To date, research has relied on self-reported mindfulness or heterogeneous mindfulness trainings to infer skillful mindfulness practice and its effects. In four independent studies with over 400 total participants, we present the first construct validation of a behavioral measure of mindfulness, breath counting. We found it was reliable, correlated with self-reported mindfulness, differentiated long-term meditators from age-matched controls, and was distinct from sustained attention and working memory measures. In addition, we employed breath counting to test the nomological network of mindfulness. As theorized, we found skill in breath counting associated with more meta-awareness, less mind wandering, better mood, and greater non-attachment (i.e., less attentional capture by distractors formerly paired with reward). We also found in a randomized online training study that 4 weeks of breath counting training improved mindfulness and decreased mind wandering relative to working memory training and no training controls. Together, these findings provide the first evidence for breath counting as a behavioral measure of mindfulness. Keywords: mindfulness, mind wandering, task-unrelated thought, attention, meta-awareness, meta-cognition, wanting, working memory training INTRODUCTION James (1890), a founder of American Psychology wrote, “the faculty of voluntarily bringing back a wandering attention over and over again is the very root of judgment, character, and will. . . . An education which should improve this faculty would be the education par excellence.” In the 1960s and more recently, others have productively followed James’s interest in wandering attention – under the overlapping terms of mind wandering, taskunrelated-thought (TUT), and stimulus-independent thought – to document that it occurs 30–50% of daily life (Klinger and Cox, 1987; Killingsworth and Gilbert, 2010), and is associated with cognitive task errors (Antrobus, 1968) and worse mood (Killingsworth and Gilbert, 2010; Wilson et al., 2014; but see Franklin et al., 2013). In contrast, research on the education of voluntarily bringing back a wandering mind has evoked both promise and controversy. Regarding its promise, the practice of returning attention to the present, which is core to mindfulness, has been associated with reduced pain (Zeidan et al., 2011), improved attention (Brefczynski-Lewis et al., 2007), and enhanced well-being (Brown and Ryan, 2003; Tang et al., 2007) among other benefits (Hölzel et al., 2011). Nonetheless, mindfulness measurements are controversial. For example, self-report on the Five Factor Mindfulness Questionnaire (FFMQ; Baer et al., 2006) cannot distinguish individuals receiving Mindfulness Based Stress Reduction vs. a validated active control intervention (MacCoon et al., 2012) because both interventions increase reported mindfulness equally (MacCoon, personal communication). In addition, mindfulness trainings and monetary incentives equally increase certain cognitive test scores, suggesting www.frontiersin.org that the demand characteristics inherent in mindfulness training studies may result in training studies measuring effects of nonspecific factors such as motivation as opposed to, or at least in addition to, mindfulness (Jensen et al., 2012). Therefore, it is unclear the extent to which mindfulness per se is captured by self-report or responsible for improvements following putative mindfulness trainings. It is therefore critical for the field to establish a behavioral and thus less biased measure of mindfulness. Unlike questionnaires, which suffer from retrospective distortions and susceptibility to implicit demand characteristics (e.g., pressure on meditators to report being mindful), behavioral measures prevent “faking good” as ability must be demonstrated instead of simply averred. A behavioral measure could also avoid the confounding, nonspecific training effects introduced in mindfulness training studies and provide a more efficient assessment. However, to our knowledge, no behavioral measure of mindfulness exists for scientific use. To address this gap, we present the first validation of such a measure. DEFINING AND OPERATIONALIZING MINDFULNESS We chose present moment awareness as a definition of mindfulness to operationalize. Grounded in traditional descriptions of mindfulness (Supplementary Material Introduction), it is a commonality in the diversity of modern scientific definitions (e.g., Brown and Ryan, 2003; Bishop et al., 2004; Baer et al., 2006; Schooler et al., 2011) and meditation styles, which variably emphasize non-attachment, non-judgment, or other facets as well. October 2014 | Volume 5 | Article 1202 | 1 Levinson et al. Mindfulness of breathing can be indexed by breath counting, which lends itself to objective behavioral study and draws face validity from its longstanding use in mindfulness practice (recorded c. 430 AD, Buddhaghosa, 2010). Prima facie, accurately counting breaths operationalizes mindfulness because it depends on (1) directly perceiving the experience of breathing in the present and (2) awareness that experience (such as mind wandering) is happening, which enables a return of attention to the breath whenever attention drifts. Therefore, although counting is not necessary for mindfulness, we propose mindfulness contributes to accurate breath counting. EVALUATING THE CONSTRUCT VALIDITY OF BREATH COUNTING AS AN INDEX OF MINDFULNESS To test the proposition that breath counting measures mindfulness, we followed the recommendations of Cronbach and Meehl (1955) for establishing such construct validity. We reasoned that if breath counting measures mindfulness, then those skilled in breath counting should exhibit all the theorized consequences of mindfulness, including more meta-awareness, less mind wandering, better mood, and greater non-attachment. The theory behind each of these links in mindfulness’s nomological network is briefly reviewed. Evaluat (...truncated)