MINCOM OFC 1(2) - javiergarciacampayo4.files.wordpress.com · Yolanda López del Hoyo Universidad...

Volume 1Issue 2Year 2016ISSN: 2445-4079

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Yolanda López del HoyoUniversidad de Zaragoza, Zaragoza, España

Bárbara Olivan BlazquezUniversidad de Zaragoza, Zaragoza, España

Mauro García ToroUniversidad de las Islas Baleares, Palma de Mallorca, España

Jesús Montero MarínUniversidad de Zaragoza, Zaragoza, España

Raquel Rodríguez CarvajalUniversidad Autónoma de Madrid, Madrid, España

Claudio Araya VelizUniversidad Adolfo Ibáñez, Santiago de Chile, Chile

Roberto Aristegui LagosUniversidad Adolfo Ibáñez, Santiago de Chile, Chile

Miguel Ángel SantedUniversidad Nacional de Educación a Distancia [UNED], Madrid, España

Luiz LópezUniversidad Federal de Paraiba, Joan Pessoa, Brasil

Gabriela RenauUniversidad Católica de Montevideo, Montevideo, Uruguay

Juan Vicente LucianoParque Sanitario Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España

David AlvearUniversidad del País Vasco, San Sebastián, España

Fabrice ParmentierUniversidad de las Islas Baleares, Palma de Mallorca, España

Sergio MorenoUniversidad San Jorge, Zaragoza, España

Nazareth CastellanoUniversidad Complutense de Madrid, Madrid, España

Agustín MoñivasUniversidad Complutense de Madrid, Madrid, España

COMITÉ EDITORIAL

EDITOR JEFEJavier García CampayoHospital Miguel Servet y Universidad de Zaragoza, Zaragoza, España

COMITÉ CIENTÍFICO

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Protección de datos: Elsevier España, S.L.U. declara cumplir lo dispuesto por la Ley Orgánica 15/1999, de 13 de diciembre, de Protección de Datos de Carácter Personal.Papel ecológico libre de cloro.Esta publicación se imprime en papel no ácido.This publication is printed in acid-free paper.

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Impreso en EspañaDepósito legal: B.12026-2016ISSN: 2445-4079

Publicación bianual (2 números al año).© Copyright 2016 Mindfulness & Compassion

Avda. Josep Tarradellas 20–30, 1º C/Zurbano, 76, 4º Izq.08029 Barcelona 28010 MadridTel.: 932 000 711 Tel.: 914 021 212

EDITORES ASOCIADOSAusias Cebolla i MartíUniversidad de Valencia, Valencia, España

Joaquim Soler RivaldiHospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España

Marcelo DemarzoUniversidad Federal de Sao Paulo, Sao Paulo, Brasil

Carmelo VazquezUniversidad Complutense de Madrid, Madrid, España

Edo ShoninNottingham Trent University, UK

William Van GordonNottingham Trent University, UK

Olga Lucia Gamboa AranaDepartment of Child and Adolescent Psychiatry, Medical Faculty, University of Cologne, Cologne, Alemania


Volume 1 / Issue 2 / 2016

Editoriales/Editorial articles

Situación actual de mindfulness y compasión en VenezuelaSituación actual de mindfulness y compasión en Venezuela

Marcos Cortez . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Historia y actualidad: mindfulness y compasión en el UruguayCurrent situation of mindfulness and compassion in Uruguay

Gabriela Renau . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Situación actual de mindfulness y compasión en ArgentinaCurrent situation of mindfulness and compassion in Argentina

Mariela de la Fuente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Original/Original article

Medición de la atención plena o mindfulness disposicional en niños y adolescentes. Revisión de las medidas de autoinforme disponibles en españolMeasurement of dispositional mindfulness in children and adolescents: A review of available self-report measures in Spanish

Esther Calvete y Estibaliz Royuela-Colomer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Revisión/Review article

Terapia de compasiónAttachment-based compassion therapy

Javier García-Campayo, Mayte Navarro-Gil y Marcelo Demazro . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Artículos especiales/Special articles

Uso corporativo de la conciencia plena y la transmisión espiritual auténtica: ¿ideales contrapuestos o compatibles?Corporate use of mindfulness and authentic spiritual transmission: Competing or compatible ideals?

William Van Gordon, Edo Shonin, Tim Lomas y Mark D. Griffi ths . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Infl uencia de la práctica de mindfulness en la apertura para conocer y comprender a los consultantes en contextos psicoterapéuticos. Un estudio cualitativo desde la perspectiva del terapeutaThe infl uence of mindfulness in the openness to understand and learn about the consultants in psychotherapeutic contexts. A qualitative study from the therapist’s perspective

María Fernanda Silva Soler y Claudio Araya-Véliz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

Ambulatório de mindfulness e promoção da saúde: relato de experiênciaOutpatient clinic of mindfulness and health promotion: experience report

Vera Lúcia Morais Antonio de Salvo, Érika Leonardo de Souza, Vinicius Terra Loyola, Marcelo Batista de Oliveira, Marcio Sussumu Hirayama, Maria Lúcia Favarato, Daniela Ferreira Araújo Silva, André Martins Monteiro, Leandro dos Reis Lucena, Patricia Silveira Martins, Ricardo Monezi Julião de Oliveira, Tatiana Berta Otero, Javier Garcia Campayo y Marcelo Marcos Piva Demarzo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

SUMARIO/CONTENTS

Mindfulness & Compassion (2016) 1, 51---52


EDITORIAL

Situación actual de mindfulness y compasión

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La Venezuela del siglo xxi, atraviesa por una profunda cri-sis en el aspecto económico, político y social, de maneraque el área de la educación, el trabajo y hasta la recrea-ción se han visto afectados. Según un informe del Centrode Estudios del Desarrollo de la Universidad Central deVenezuela (Cendes-UCV), lo anterior ha generado un efectonegativo en la salud mental de los venezolanos, por lo cualse desglosó una serie de emociones negativas como conse-cuencia de dicha crisis. Tal es la gravedad de esta situaciónen el país que la Federación de Psicólogos de Venezuela,junto a una red de apoyo integrada por la Universidad Cen-tral de Venezuela (UCV), la Universidad Metropolitana (UM),la Universidad Simón Bolívar (USB) y la Universidad Cató-lica Andrés Bello (UCAB), en 2015 se pronunciaron sobre elestado crítico en el que se encuentra sumergida la poblaciónvenezolana, dado que el estudio anteriormente mencionado(Red de Apoyo Psicológico, & Federación de Psicólogos deVenezuela, 2015) arrojó un predominio de emociones nega-tivas, tristeza, miedo, irritabilidad, ansiedad, depresión yestrés, planteamientos que concuerdan con otras investi-gaciones recientes, y que además refieren a la violencia einseguridad que vive el país (Acosta, 2015; Rodríguez, 2015;Sánchez & Lugo, 2015).

Ante este panorama, agudizado a lo largo de 16 anos demalas gestiones, se viene realizando un trabajo de inves-tigación y difusión sobre el mindfulness en Venezuela. Sinembargo, ya desde la década de los anos 90 han sido regis-trados trabajos relacionados con la intervención integral dela familia en el manejo no farmacológico de la hiperten-sión arterial, siendo la meditación una de las medidas deintervención (Soteldo et al., 2010).

En este sentido, en julio de 2013 la psicólogo JosefinaBlanco Baldo y el psicólogo Ángel Paz presentaron en elIII Congreso Internacional de Psicología Positiva una investi-gación poster sobre los efectos positivos del mindfulness enVenezuela, donde contaron con el apoyo de la UniversidadMetropolitana y la Sociedad Venezolana de Psicología Posi-
tiva (Blanco & Paz, 2013). De igual forma, actualmente seobserva un incremento sobre la difusión de mindfulness através de la prensa, entrevistas en radio y televisión, ela-boración de micros y una mayor oferta de talleres dirigidos
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empresas y al personal docente, conferencias en liceos yniversidades. En lo que respecta a la salud se han aplicadoerapias de tercera generación para disminuir los efectos delstrés, la ansiedad y la depresión.

En vista del crecimiento del mindfulness en Venezuela,a UM lo ha ido incorporando en su pénsum de estudios,e tal manera que ya forma parte del diplomado de psi-ología positiva. Igualmente, en el Instituto Universitariolberto Adriani se ha incorporado en la temática relacio-ada con las habilidades sociales y como una herramientan la disminución y control del estrés.

Ante tal panorama, la clínica psicológica comienza augar un papel protagónico, dada la realidad que vive elenezolano, donde el pasado trae recuerdos de abundanciaun en las peores circunstancias. Es por ello que para muchosurgen las siguientes interrogantes: ¿Estábamos mejor en elasado? ¿Cuándo se dará el cambio en el presente? Esta esa conversación diaria entre los venezolanos. Sin embargo,s importante que se entienda que lo necesario de acep-ar el presente, no resignarse, pero sí actuar para cambiara situación. Por ello mindfulness juega un papel fundamen-al como herramienta psicológica, ya que permite aceptar laealidad, disminuir el sufrimiento y centrarse en el presente.indfulness surge también como una estrategia valiosa para

a búsqueda de caminos que lleve a su población a una inter-ención integral dirigida a minimizar los efectos negativosue se generan como producto de la situación descrita.

ibliografía

costa, Y. (2015). Venezuela: un país sitiado por el dolor y el miedo.Revista SIC Centro Gumilla. Recuperado a partir de http://revistasic.gumilla.org/2015/venezuela-un-pais-sitiado-por-el-dolor-y-el-miedo/

lanco, J, & Paz, A. (2013). Mindfulness Based Training and PositiveAffect. A Pilot Study in Venezuela. En: IPPAT Third World Con-gress Program. Los Angeles: International Positive PsychologyAssociation.

ed de Apoyo Psicológico, & Federación de Psicólogos de Vene-zuela. (2015). Pronunciamiento de la Red de Apoyo Psicológico(Rap-UCV /UCAB /USB /UNIMET) y la Federación de Psicólo-gos de Venezuela, ante el impacto psicológico de la actual

ana, S.L.U. Todos los derechos reservados.

dx.doi.org/10.1016/j.mincom.2016.10.007

http://www.elsevier.es/mindcomp

http://crossmark.crossref.org/dialog/?doi=10.1016/j.mincom.2016.10.007&domain=pdf

http://revistasic.gumilla.org/2015/venezuela-un-pais-sitiado-por-el-dolor-y-el-miedo/




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crisis socio-económica y política venezolana. Caracas, Vene-zuela. Recuperado a partir de http://goo.gl/0J15Zj

odríguez, F. (2015). Violencia social aumentada en Venezuela:sociogénesis del mal. Guayana Sustentable, (13), 263---278.

ánchez, G. S. & Lugo, G. J. S. (2015). Violencia y salud colectiva:
un desafío antropológico sociocultural. Comunidad y Salud, 1,64---77.
oteldo, I., Cortez, M., Gil, Z, Colmenares, A., Alvarez, H., &Arias, F. (2010). Intervención integral de la familia en el manejo

EDITORIAL

no farmacológico de la hipertension arterial leve y marginal.Revista Avances Contra la Ateroesclerosis, 7(2), 2-4.

Marcos Corteza,b

Instituto Universitario Alberto Adriani, Caracas, DistritoCapital, Venezuela

b Asociación Venezolana de Aterosclerosis (AVA)Correo electrónico: [email protected]

http://goo.gl/0J15Zj

http://refhub.elsevier.com/S2445-4079(16)30029-5/sbref0015







































mailto:[email protected]



EDITORIAL

Historia y actualidad: mindfulness y compasión en elUruguay

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La cultura occidental parece precisar de un salvavidas quenos saque a flote de un mundo basado casi exclusivamenteen lo material, con cambios cada vez más acelerados, dondelos pilares sobre los cuales se cimenta la sociedad parecenreconvertirse más rápido de lo que las personas pueden asi-milar. Los cambios se despliegan de manera exponencial,la dificultad de adaptarnos a los cambios y el estrés queello conlleva parece dejarnos sin suelo donde pisar. Una vezalguien preguntó ¿por qué creen que triunfó Freud? La res-puesta fue «porque el mundo de aquel entonces precisabalo que Freud les estaba diciendo». Lipovetsky describe laactualidad como «la era del vacío» (Lipovetsky, 2003), unvacío que ha intentado colmarse con aspectos económicos ymateriales. No hemos alcanzado la felicidad con ello: el serhumano, con la mayoría de sus necesidades básicas satisfe-chas, siente el vacío interno, su existencia empieza a perdersentido, los valores se han vuelto difusos.

El término mindfulness, definido por Thich Nhat Hanhcomo «mantener viva la consciencia en la realidad delpresente» (Hanh, 2014), es una habilidad que todos llevamosdentro, nacemos con ella, constituye un rasgo en la perso-nalidad que podemos cultivar o no. En el mundo oriental sehan dedicado a desarrollar esta habilidad, mientras los occi-dentales nos hemos dedicado a otras cosas. . ., hasta ahora.Y después de más de 2.600 anos de su ejercitación en elmundo oriental, los occidentales hemos comenzado a prac-ticar mindfulness, para llenar justamente aquel vacío. Hoyencontramos artículos sobre mindfulness por doquier. Justa-mente, el mundo posmoderno es lo que está precisando eneste momento.

La atención plena, o vivir conscientemente, podría ser elcomienzo de una nueva era: la era de la compasión haciauno mismo y hacia los demás. Luego de intentar controlarlotodo, tratar de vernos «mejor» físicamente, ser más ricos,más inteligentes, adquirir más títulos, etc. Luego de tanto
esfuerzo por llegar a ser como «deberíamos ser» nos damoscuenta de que simplemente ser humanos ya es suficiente.
El declive de las religiones cristianas como fuerzadominante en la ensenanza de los valores da paso a su

ciil

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mpassion in Uruguay

ransformación en la era posmoderna, y la compasiónparece de la mano del mindfulness, retomando los valorese siempre, los valores que toda religión ha promovido a suanera pero, en este caso, sin un ser superior, sin premios

i castigos, sin dogmas. Los valores los crea uno, teniendon cuenta al otro. La paz interior y el bienestar que todosnhelamos va de la mano de ser coherentes con nuestrosropios valores. Ser fieles a nosotros mismos, cuidarnos,espetarnos y ser nuestro mejor amigo, incluso cuandorramos. Y a partir de esto «amarás al prójimo como a tiismo» (La Biblia, 2016), de lo contrario, este mandamientoerdería su sentido. La atención plena es el primer paso enste camino que empezamos a recorrer como humanidad.

En Uruguay, la llegada del mindfulness, es relativamenteeciente. En el ano 2009, 2 semillas sembraron el interés derofundizar en esta temática. Por un lado, en el marco delosgrado de Psicología Cognitiva de la Universidad Católicael Uruguay se invitó a M.a Noel Anchorena de Argentina,irectora de la Sociedad Mindfulness y Salud, a realizar uneminario dirigido a los alumnos del posgrado y a la primeraornada de atención plena que se realizó en Uruguay. Portro lado, un grupo de profesionales de la salud, dedicadol estudio de la integración en psicoterapia, se encontrabarofundizando acerca de la terapia dialéctica del compor-amiento de manera particular. A partir de ello, algunos deos miembros de dicho grupo, específicamente 3 psicólogasMargarita Ungo, Beatriz Batlle e Ilse Lustenberger), se moti-aron para profundizar más acerca del mindfulness. A finesel 2011 invitaron a Fernando A. de Torrijos a Uruguay paraealizar el primer y único practicum que se ha desarrolladon nuestro país. Estas 2 semillas despertaron el interés deos profesionales de la salud, que crearon rápidamente unaed de intercambios y profundización en la temática.

En el ano 2011, nació la Sociedad para la Exploración ystudio de la Integración en Psicoterapia (SEEIP). La SEEIP
onstituye una red de profesionales de la salud mental,nteresados en la exploración y estudio del campo de lantegración en psicoterapia. La SEEIP se materializa ena formación de distintos grupos de estudio, 2 de los cuales
indfulness & Compassion.





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e centran en mindfulness y psicoterapia. Desde aquel ano,e han reunido semanalmente profesionales de la salud pararacticar, estudiar y compartir mindfulness. En estos gruposoincidieron la mayoría de los profesionales que facilitan,ctualmente, programas de mindfulness en Uruguay, algunose ellos: Silvana Abbate (miembro del equipo del Hospitalritánico), Margarita Ungo (cofundadora del Proyecto Mind-ulness), Carlos Cabrera (fundador de Herramientas para laalud) y Gabriela Renau (cofundadora de Bien-Estar). Estoermitió compartir experiencias acerca de la implementa-ión de los programas, así como coordinar y promover enuestro país distintas actividades vinculadas a la prácticael mindfulness como una forma de vida.

A partir de este ano comienzan a desarrollarse progra-as de 8 semanas basados en mindfulness, impartidos poristintos profesionales, entre ellos, los antes mencionados,ue apuntan a promover el bienestar de los participantes.

Al finalizar el programa, los participantes se preguntan¿y ahora qué?». Según nuestra experiencia, las 8 semanason una introducción al cambio, son el pantallazo gene-al que inicia el camino. El «ahora qué» nos ha llevado arofundizar y pensar alternativas. Luego de los programase realizan encuentros de mantenimiento, con frecuenciaemanal, encuentros que pretenden profundizar en la prác-ica y promover el hábito de la meditación formal e informalntroduciendo nuevos aspectos. Como lo explican el Dr.avier García Campayo, la Lic. Pilar Ínigo Gías, el Dr. Mar-elo Demarzo y Mayte Navarro-Gil en su artículo «Grupose mantenimiento en mindfulness: el modelo de la Univer-idad de Zaragoza» (García Campayo, Ínigo Gías, Demarzo

Navarro-Gil, 2015), estos grupos son de gran importan-ia para el mantenimiento de la práctica. A su vez, hemosuscado nuevas posibilidades, dado que cada encuentro deantenimiento implica un costo para los interesados, apun-

ando a la autogestión de los grupos de práctica. A partir deetiembre del ano 2015 se ha propuesto, para todos los quean transitado por un programa de 8 semanas, la posibili-ad de participar en un grupo de encuentro con frecuenciaensual. Estos encuentros se llevan a cabo en una casa par-

icular, donde se promueve que el anfitrión reciba con un té cada participante lleve algo para compartir. Hemos invo-ucrado a todos los interesados en la organización de losncuentros, de tal manera que la actividad se gestione deanera autónoma. En cada encuentro se propone un sitioue abrirá sus puertas al mes siguiente y un encargado deomunicar el lugar de la cita unos días antes. El objetivoe este modo de funcionamiento es que ellos creen su pro-io grupo de práctica, incluso podrían crearse varios gruposegún las necesidades de los participantes. Actualmente sea conformado un grupo estable, al cual se suman mes a mesás personas. La temática de cada encuentro se decide en

l momento según el interés del grupo. Todos han expresadoue la existencia de este espacio los ha llevado a retomara práctica diaria. Además se ha generado a través de lasedes sociales una forma de comunicación que promueve elntercambio entre los participantes. A través de este medio,or ejemplo, se comparten prácticas, videos y artículos.

Por otro lado, algunos de los programas basados en mind-ulness introducen un encuentro centrado en la compasión.
uienes transitan por uno de estos programas solicitan conti-uar profundizando en esta temática. Notan que su prácticaes genera un importante bienestar y les resulta sumamente
fiAu

EDITORIAL

ifícil cultivar la compasión y, sobre todo, la autocompasión.os profesionales que nos dedicamos a promover esta formae vida estamos al servicio de lo que las personas precisanara lograr un estado de mayor calma. En este sentido, Paularandino (cofundadora del Proyecto Mindfulness) acaba deulminar la formación en mindful self-compassion con el Dr.hristopher Germer. Ha desarrollado, durante el 2015, algu-os talleres de media jornada y 2 ciclos de 4 encuentrosasados en la compasión hacia uno mismo y hacia los demás.n setiembre de este ano comienza el primer programa deindful self-compassion del Uruguay.Me gustaría senalar que el término compasión, tal como

omenta Simón (2015), también en nuestro país tiene unaonnotación negativa, al confundirse con «lástima» como loefine la Real Academia Espanola. Por este motivo es comúnue utilicemos el término «amabilidad» en los talleres y pro-ramas dedicados a la compasión. Paulatinamente vamosncorporando el término compasión, definiéndolo como apa-ece en el Diccionario de uso del espanol de María Molinersentimiento de pena provocado por el padecimiento detros, e impulso de aliviarlo, remediarlo o evitarlo».

En términos de investigación, queda mucho por hacer.n este sentido podemos destacar el trabajo realizado enl Hospital Británico, en el cual los profesionales que pro-ueven los programas deben presentar anualmente los

esultados observados. El Dr. Roberto Superchi (cardió-ogo) y su equipo, conformado por una nutricionista (Marenorheim) y 2 psicólogas (Silvana Abbate y Anabel Viera),esarrollan programas de reducción de estrés basados enindfulness desde el 2011. Este programa se ofrece a todos

os afiliados del seguro médico (mayores de 18 anos) deanera gratuita. Antes y después del programa se aplica a

os participantes el SCL-90 y se observan cambios significati-os en todos los puntos de importantes a muy importantes. Au vez, desde el ano 2014, al terminar el programa, los par-icipantes tienen la oportunidad de transitar un programaasado en la compasión de 4 semanas de duración. Este pro-rama es una adaptación abreviada del programa de Kristineff y Christopher Germer. Al comienzo del programa deeducción de estrés de 8 semanas se aplica el cuestionarioe autocompasión de Kristin Neff (EAC) y se aplica nueva-ente al final del complemento de compasión. En el score

lobal de compasión se aprecia un cambio de 3,03 a 3,65.e observa también que los resultados son favorables en los

rubros que analiza la encuesta: mindfulness, vínculo conno mismo y vínculo con los otros. Al culminar ambos pro-ramas consecutivos, los participantes tienen la posibilidade concurrir a un espacio grupal de 40 semanas de dura-ión en el que se profundiza la práctica de mindfulness ye compasión vinculada a hábitos saludables que promue-an el bienestar físico y emocional. En estos encuentrosemanales de una hora y media de duración se trabaja elqué y cómo ser compasivo» tanto con uno mismo como conos demás. Al comienzo y al finalizar este programa psicoe-ucativo se aplican a los participantes 6 cuestionarios (CD:onducta diagnóstica; Afi: actividad física; VS: vulnerabili-ad somática; IMC: índice de masa corporal; FA: forma delimentarse; RV: riesgo vascular). Se observa que el prome-io de las variables que alcanzan el nivel satisfactorio al
nalizar el proceso es de 4 de las 6 variables indagadas.demás, un ano después de finalizado el curso se realizan seguimiento aplicando nuevamente los cuestionarios y

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se destaca que los cambios favorables se han mantenidoe incluso profundizado. Vale destacar que los 3 programasconsecutivos se ofrecen de manera gratuita a los afiliados alseguro médico, un gran ejemplo para las demás institucionesmédicas con el fin de favorecer la salud y la prevención.

En lo referente al ámbito académico, en el ano 2013la SEEIP ofreció el primer curso de mindfulness con 7módulos dirigido a profesionales de la salud, al cual asis-tieron 37 personas. El Lic. Carlos Cabrera ofreció programasexclusivamente para psicólogos y profesionales de la saludcentrados en la práctica del terapeuta. Durante el 2015,en el marco del Posgrado de Psicología Cognitiva de la Uni-versidad Católica del Uruguay, las psicólogas Mónica Pigatto(directora de Atha Coaching & Mindfulness) y Gabriela Renaudictaron un seminario de «Introducción al mindfulness», elcual consistió en 5 módulos. En el 2016 invitamos a Uruguayal Dr. Javier García Campayo a dictar un seminario sobremindfulness al cual asistieron 80 personas, con algunos inte-resados que quedaron en lista de espera. Además facilitó unretiro de 3 días, en el cual, el 86% de los participantes eran
profesionales de la salud. Esto demuestra que el interés ennuestro país ha aumentado de manera exponencial por partede los profesionales de la salud, sin haber encontrado, porel momento, un espacio para la formación en mindfulness.
55

Si bien se trabaja de manera insistente para introdu-ir el mindfulness en el país, todavía queda mucho porecorrer, especialmente en el ámbito educativo, empresa-ial y en el sistema sanitario. Confío en que cada vez habráás profesionales formados en mindfulness para poder

eguir ampliando la red y llevar esta práctica a todo elaís.

ibliografía

arcía Campayo, J., Ínigo Gías, P., Demarzo, M. y Navarro-Gil, M.(2015). Grupos de mantenimiento en mindfulness: el modelode la Universidad de Zaragoza. Actas Espanolas de Psiquiatría,Suplemento.

anh, T. N. (2014). El milagro de mindfulness. Edit. Oniro.a Biblia, Mateo 22:39.ipovetsky, G. (2003). La era del vacío. Edit. Anagrama.imón, V. (2015). La compasión: el corazón del mindfulness. Edit.

Sello.

Gabriela RenauUniversidad Católica de Montevideo, Montevideo, Uruguay

Correo electrónico: [email protected]













































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DITORIAL

ituación actual de mindfulness y compasiónn Argentina

urrent situation of mindfulness and compassion in Argentina

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l mindfulness ingresa a la Argentina de la mano de Claraadino.

Desde el ano 1993, Visión Clara se dedica a la ensenanzae la práctica meditativa de mindfulness en el país. En elno 1999 Clara conoce a Jon Kabat-Zinn. Un ano más tardel Dr. Kabat-Zinn y el licenciado Torrijos, llegan a Bue-os Aires invitados por Clara Badino y el Dr. Máximo de laega, donde realizaron conferencias y seminarios destinadosanto al público general, como a profesionales de la salud.se mismo ano son invitados por el propio Kabat-Zinn, almega Institute de Nueva York y al centro de la UMAss, paraapacitarse como instructores de Mindfulness Based Stresseduction (MBSR). Desde agosto del 2000, Visión Clara-indfulness Argentina, asociación sin fines de lucro, ensenal programa MBSR en distintos lugares de la capital federaluenos Aires, y en los últimos tiempos también en la ciu-ad de Rosario, tanto en su formato de 8 semanas, como enodalidades intensivas y online, ayudando a la formación de

umerosas personas, no solo de Buenos Aires, sino tambiénel interior del país, como de países limítrofes.

Este equipo de trabajo no solo fue pionero en ensenarl programa MBSR en Argentina, También lo es actualmentel instruir el primer programa de formación de instructo-es en mindfulness, y el primer programa de formación denstructores mindfulness en el deporte (formación en mind-ulness con especialización en deporte), ambos de 4 anos deuración.

Desde los comienzos de la ensenanza de mindfulnessn Argentina, en la década de los 90, podemos encontrartros centros que hoy en día ensenan mindfulness, conrofesionales formados tanto en el exterior, como en elaís.

En términos generales estos lugares se centran en las ciudades más grandes de la Argentina: Capital Federal,órdoba y Rosario, con esto no quiero decir que no exis-an otros lugares que trabajen con mindfulness. También

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e puede decir que en su mayoría, los centros que tra-ajan con mindfulness en Argentina esta manejados porsicólogos o profesionales de la salud mental, realizandoambién tareas asistenciales. Por otro lado, algunos de estosentros también imparten el programa MBSR. En los últi-os anos, gracias al avance tecnológico, se están dando

o solo de manera presencial, sino también en formatonline, permitiendo gozar de los beneficios de dicha for-ación, y facilitando la accesibilidad a un mayor número deersonas. También se brindan cursos de mindfulness parasicoterapeutas. Distintos tipos de formaciones, talleres,orkshops, cursos de mindfulness destinados al público eneneral, a empresas, a profesionales de la salud, de la edu-ación (siendo muy incipiente, todavía, la aplicación deindfulness a escuelas y a otros ámbitos educativos), cursosestinados a comer consciente, como así también a personaselacionadas con el mundo del deporte (contando actual-ente con centros que trabajan mindfulness con deportistase alto rendimiento). Cabe recalcar que algunos de estosentros están realizando también tareas científicas denvestigación.

Otro importante punto a senalar es que este, es elegundo ano que se está llevando a cabo el curso univer-itario de posgrado de mindfulness y sus aplicaciones paraa salud, organizado por el instituto de neurociencias de laundación Favaloro.

Con respecto a la compasión y autocompasión, la mayo-ía de los centros nombrados anteriormente, las incorporann sus formaciones, cursos, talleres, etc. De una maneranformal. Por otro lado, contamos en Argentina con la licen-iada Fanny Libertun, psicóloga y psicopedagoga, quién fueormada por los creadores del programa MSC, Chistopherermer y Kristin Neff, en Mindful Self-Compassion (MSC):
ore Skills training. Ensenando actualmente el programaSC en nuestro país. Y desde hace poco tiempo, también
engo el agrado de haber realizado el Teacher Training,

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EDITORIAL

obteniendo el título de teacher-in-training (profesora en
formación) del programa MSC. Esperando poder lograr juntoa colegas del mindfulness, de la compasión y de la autocom-pasión, que estas áreas se sigan desarrollando y creciendoen mi país.
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Dirección de Especialidades Médicas, Municipalidadde Córdoba, Córdoba, Argentina

Correo electrónico: [email protected]


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RIGINAL ARTICLE

easurement of dispositional mindfulness in childrennd adolescents: A review of available self-reporteasures in Spanish

sther Calvetea,∗, Estibaliz Royuela-Colomerb

University of Deusto, SpainVrije Universiteit Amsterdam, The Netherlands

eceived 25 September 2016; accepted 3 October 2016vailable online 24 November 2016

KEYWORDSDispositionalmindfulness;Self-reports;Children;Adolescents

Abstract In recent years, mindfulness-based interventions have undergone considerabledevelopment in the field of childhood and adolescent interventions. This development hasnot been accompanied by a solid and systematic development of self-report measures to assessdispositional mindfulness even though such evaluation is critical to determine the effectivenessof interventions. In this manuscript, several mindfulness measures for children and adolescentsare reviewed with emphasis on those measures available in Spanish. The following self-reportmeasures of dispositional mindfulness for children and/or adolescents are examined: MindfulAttention Awareness Scale-Adolescent (MAAS-A; Brown et al., 2011), Mindful Attention Aware-ness Scale-Children (MAAS-C; Lawlor et al., 2014), Child and Adolescent Mindfulness Measure(CAMM; Greco et al., 2011), Comprehensive Inventory of Mindfulness Experiences-Adolescent(CHIME-A; Johnson et al., 2016), Escala de Atención Plena en el Ámbito Escolar [Mindfulness inthe School Context Scale] (EAP; León, 2008), and Five Facet Mindfulness Questionnaire (FFMQ;Baer et al., 2006). A description of each measure is provided, as well as the most importantproperties of the Spanish versions. Finally, several recommendations are suggested to improvecurrent measures of mindfulness for children and adolescents.© 2016 Mindfulness & Compassion. Published by Elsevier Espana, S.L.U. All rights reserved.

PALABRAS CLAVE Medición de la atención plena o mindfulness disposicional en ninos y adolescentes.
Atención plena o Revisión de las medidas de autoinforme disponibles en espanol
nos, las intervenciones basadas en la atención plena o mindfulnessiderable desarrollo en el campo de las intervenciones en la infancia yollo no ha estado acompanado por un desarrollo sólido y sistemático

mindfulnessdisposicional;Autoinformes;

˜

Resumen En los últimos ahan experimentado un consla adolescencia. Este desarr
Ninos;
Adolescentes de las medidas de autoinforme para evaluar la atención plena disposicional a pesar de que

∗ Corresponding author.E-mail address: [email protected] (E. Calvete).

ttp://dx.doi.org/10.1016/j.mincom.2016.11.001445-4079/© 2016 Mindfulness & Compassion. Published by Elsevier Espana, S.L.U. All rights reserved.






Dispositional mindfulness in children and adolescents 59

dicha evaluación es fundamental para determinar la eficacia de las intervenciones. En esteartículo se revisan varias medidas de atención plena para ninos y adolescentes y se hacehincapié en las medidas disponibles en espanol. Se estudian las siguientes medidas de autoin-forme de atención plena disposicional para ninos y adolescentes: Mindful Attention AwarenessScale -Adolescent (MAAS-A; Brown et al., 2011), Mindful Attention Awareness Scale -Children(MAAS-C; Lawlor et al., 2014), Child and Adolescent Mindfulness Measure (CAMM; Greco et al.,2011), Comprehensive Inventory of Mindfulness Experiences-Adolescent (CHIME-A; Johnsonet al., 2016), Escala de Atención Plena en el Ámbito Escolar [Mindfulness in the School ContextScale] (EAP; León, 2008), y Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006).Se ofrece una descripción de cada medida, así como las propiedades más importantes de lasversiones en espanol. Por último, se sugieren varias recomendaciones para mejorar las medidasactuales de la atención plena de ninos y adolescentes.© 2016 Mindfulness & Compassion. Publicado por Elsevier Espana, S.L.U. Todos los derechosreservados.

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Introduction

Mindfulness-based interventions are increasingly used withchildren and adolescents. Two recent reviews concludedthat mindfulness-based interventions are beneficial foryouth (Felver, Celis-de Hoyos, Tezanos, & Singh, 2016;Kallapiran, Koo, Kirubakaran, & Hancock, 2015). Mindfulnesstraining reduces psychological problems such as depression,anxiety, and externalizing problems, and improves attentionand academic achievement. Although mindfulness-basedinterventions are promising, very little is known aboutthe mechanisms through which mindfulness acts (Calvete,2017; Felver et al., 2016). Overall, it is expected thattraining in mindfulness will help improve dispositionalmindfulness, which in turn acts as a resilience factorfor coping with stress and adversity (Calvete, Orue, &Sampedro, 2016). However, most studies on the effective-ness of mindfulness-based interventions do not examinewhether dispositional mindfulness changes as a conse-quence of the intervention. The study of the mechanismsby which mindfulness training produces positive outcomesis necessary to maximize the effectiveness of inter-ventions by enhancing the active components and toinform theory development and interpretation of find-ings (Kazdin, 2007). Measurement of mindfulness is alsoimportant for testing models of the construct of mindful-ness, identifying predictors and outcomes, and studyingthe developmental trajectory of dispositional mindfulnessacross the lifespan (Pallozzi, Wertheim, Paxton, & Ong,2016).

Unfortunately, the rapid growth of mindfulness-basedinterventions has not been accompanied by a developmentof valid measures of dispositional mindfulness. Research onthe mindfulness construct and psychometric characteristicsof its measures is still at an early stage, and there is noconsensus on how mindfulness should be conceptualized and
measured (Andrei, Vesely, & Siegling, 2016). If this scenariois negative for the measurement of mindfulness in adults,the situation is even more challenging in children and ado-lescents.
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In this scenario of lack of consensus, there is a varietyf questionnaires to assess mindfulness. Most of them werereated in a relatively short period. For instance, during

five-year period, eight self-report measures of disposi-ional mindfulness were published (see for a review, Rau &illiams, 2015). In general, most of the available measures

re inspired in an Eastern conception of mindfulness thateflects a contemplative tradition rooted in Buddhism, andighlight the aspects of purposeful attention to and aware-ess of the present moment with a nonjudgmental attitudef openness and acceptance (Andrei et al., 2016).

One of the most important characteristics that distin-uish different approaches to the assessment of dispositionalindfulness refers to the measurement model of the

onstruct. Evidence from several measures suggests thatindfulness is a unitary construct (e.g., Brown & Ryan,

003). In contrast, other measures have been built on theasis of a conceptualization of mindfulness as a multidi-ensional construct. Two important dimensions that are

ncluded in multiple measures are awareness (or presence)nd acceptance (or non-judging). These two dimensionsrovide the strongest theoretical and empirical associa-ion with the mindfulness construct (Rau & Williams, 2015).owever, whereas these two dimensions are common in sev-ral measures of mindfulness, some other measures includedditional dimensions such as observing, describing, andon-reacting. Observing captures the importance of notic-ng internal and external stimuli (Baer, Smith, & Allen,004). Description includes the use of words to describend label the observed phenomena (Segal et al., 2002).on-reaction refers to the ability to observe thoughts andeelings without being influenced by them (Baer, Smith,opkins, Krietemeyer, & Toney, 2006). Interestingly, thebserving dimension has been controversial, as its roleeems to differ depending on the characteristics of the sam-le. The different functioning of observing has led to thelimination of the dimension in some questionnaires.

Measures of mindfulness have only recently been adaptedor use with children and adolescents. For instance, Greco,aer, and Smith (2011) used the Kentucky Inventory of

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indfulness Skills (KIMS; Baer et al., 2004) to develop thehild and Adolescent Mindfulness Measure (CAMM). Sim-

larly, two youth measures were based on the Mindfulttention Awareness Scale (MAAS; Brown & Ryan, 2003): theAAS for adolescents (MAAS-A; Brown, West, Loverich, &iegel, 2011) and the MAAS for Children (MAAS-C; Lawlor,chonert-Reichl, Gadermann, & Zumbo, 2014).

The assessment of mindfulness in children and ado-escents involves important challenges. Cognitive andmotional development in children and adolescents isncomplete, and their reading skills and capacity for self-eflection are more limited (Pallozzi et al., 2016). Grossman2011) suggested that self-report measures of mindfulnessere unreliable at these developmental stages. Neverthe-

ess, the review by Pallozzi et al. (2016) indicated that somef the available measures of mindfulness are adequate forhildren and adolescents.

Most of the youth measures were first developedor English-speaking populations and then translated anddapted to other countries and languages. Specifically, threeeasures were adapted for use in Spanish-speaking chil-ren and adolescents: Cuestionario de las Cinco Facetase Mindfulness-Adolescentes (FFMQ-A; Royuela-Colomer &alvete, 2016), La Escala de Atención y Conciencia Plenaara Adolescentes (MAAS-A; Calvete, Sampedro, & Orue,014), and Medida de Mindfulness en Ninos y AdolescentesCAMM; Turanzas Romero, 2013; Vinas, Malo, González,avarro, & Casas, 2015). In addition, León (2008) devel-ped La Escala de Atención Plena en el Ámbito Escolar inpain. These assessment tools are widely used, and theirsychometric properties have been analyzed independentlyn several studies (Bruin, Zijlstra, & Bögels, 2013; Kuby,cLean, & Allen, 2015). To date, however, there are no stud-

es that provide a concise summary of the existing childrennd adolescent mindfulness measures for Spanish-speakingopulations. In this review, we examine the characteristicsf the available questionnaires in Spanish to assess disposi-ional mindfulness in children and adolescents.

bjective of the current review

his paper offers an overview of the current status in theeld on self-report assessment of mindfulness in childrennd adolescents internationally and in Spain and Spanish-peaking populations. The following assessment tools arexamined: MAAS-A (Brown et al., 2011), MAAS-C (Lawlort al., 2014), CAMM (Greco et al., 2011), CHIME-A (Johnson,urke, Brinkman, & Wade, 2016), EAP (León, 2008), andFMQ (Baer et al., 2006). A description of each measures provided, as well as the most important properties forach measure. Table 1 displays a summary of the reviewedeasures.

verview of available mindfulness scales

he mindful attention awareness scale (MAAS;rown & Ryan, 2003)

he MAAS is probably the most widely used unidimensionaleasure of mindfulness. Brown and Ryan (2003) based theAAS on a conceptualization of mindfulness as enhanced

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ttention to and awareness of current experience or presenteality. The MAAS differs in its origins from other measuresn that it was derived both from historical and contemporaryuddhist scholarship on mindfulness and from clinical theorynd research on the practice of mindfulness (Brown et al.,011). Although the original version of the MAAS includedwo factors --- presence and acceptance --- the acceptanceomponent was excluded because the authors consideredhat it was redundant and did not increase validity.

The MAAS consists of 15 items that describe the absencef mindful attention in various circumstances (e.g., ‘‘I tendo walk quickly to get where I’m going without paying atten-ion to what I experience along the way’’, ‘‘I snack withouteing aware of what I am eating’’). Items are responded on aix-point response scale ranging from 1 (almost never) to 6almost always) so the total score ranges between 15 and0. This indirect assessment approach has been criticized,s the scale could measure attentional failures or runningn ‘‘automatic pilot’’ rather than dispositional mindfulnessRau & Williams, 2015). However, in the opinion of Brownnd Ryan (2003), items reflecting less mindlessness are likelyore accessible to most individuals because mindless states

re much more common than mindful states.Although the MAAS is a brief measure, it has shown

xcellent psychometric properties in terms of internal con-istency, test---retest reliability, and factor structure (Deruin et al., 2011). The Spanish translation has shownood properties in adults (Soler Ribaudi et al., 2012). TheAAS scores are associated with the practice of medita-

ion (Brisbon & Lowery, 2011) and are negatively correlatedith several psychological problems (e.g., Black, Sussman,ohnson, & Milam, 2012; Jermann et al., 2009).

Brown et al. (2011) slightly adapted the MAAS to adoles-ents (MAAS-A) by removing one item relating to driving. TheAAS-A has displayed adequate psychometric properties indolescent samples. For instance, the authors found thatronbach’s alpha ranged between .84 and .93 (Brown et al.,011). The MAAS-A has been used as an outcome indicatorn several mindfulness-based interventions with adolescentsPallozzi, Wertheim, Paxton, & Ong, 2016). For instance,rown et al. (2011) conducted an intervention study with asychiatric group of adolescents and found that these ado-escents showed increases in MAAS-A scores after trainingn mindfulness, and that the improvement in dispositionalindfulness was significantly related to positive changes inell-being. Furthermore, the MAAS-A has been used in sam-les of adolescents of several countries, including Spain.he Spanish version of the MAAS-A presents excellent psy-hometric properties (Calvete et al., 2014). The results in aarge sample of Spanish adolescents aged between 12 and 18ears confirmed the one-factor structure of the MAAS-A andndicated a Cronbach’s alpha of .85. The scores were neg-tively correlated with symptoms of depression, antisocialehavior, anger, drug abuse, and lack of self-control (Calvetet al., 2014).

Benn (2004) modified the MAAS to use with younger popu-ations by altering the language to be age-appropriate andhanging the six-point Likert-type scale to a more child-
riendly format. For instance, the item about driving washanged to ‘‘walking into a room, and then wondering why
went there’’. Findings of a recent study with a samplef children indicated that the MAAS-C displays high internal

Dispositional

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61

Table 1 Summary of main characteristics of available measures of mindfulness for children and adolescents.

Name of thescale

Dimensions Number ofitems/responseformat

Psychometric properties(internal consistency,test---retest)

Age range of sampleswhere the questionnairehas been used

Availabilityin Spanish

Adequacy for children andadolescents andrecommendations

MAAS-A (Brownet al., 2011)

1. Acting with awareness 14 items/6response options

Adequate 14---18 yrs. Yes Yes. However, instructionsshould be revised toincrease readability andresponse format should bereduced to 5 options

MAAS-C (Lawloret al., 2014)

1. Acting with awareness 15 items/6response options

Adequate Fourth to seventh grade.Mean age = 11.43 yrs.(SD = 1.07).

No Yes. However, responseformat should be reducedto 5 options

CAMM (Grecoet al., 2011)

1. Acting with awareness andnon-judging

10 items/5response options

Adequate 9---18 yrs. Yes Yes. However, theunderstanding of the itemsmight be more difficult inyoung children, as most ofthe items arereverse-scored and abstract

CHIME-A(Johnsonet al., 2016)

1. Internal experienceawareness2. External experienceawareness3. Acting with awareness4. Accepting and non-judgment5. Non-reactivity6. Openness7. Relativity of thoughts8. Insightful understanding


Adequate consistencyexcept for the Opennessscale.Poor test---retestcorrelation

12---14 yrs. No More research is needed. Itis a promising approach tomeasure different aspectsof mindfulness in youth

EAP (León,2008)

1. Kinesthetic attention2. External attention3. Internal attention


Low consistency forOpenness subscale

12---16 yrs. Yes More research is needed. Itdoes not provide a completeapproach to mindfulness, asit only assesses awarenessand it should be combinedwith other measures

FFMQ-A (Baeret al., 2006)

1. Acting with awareness2. Observing3. Describing4. Non-judging5. Non-reactivity


Adequate 13---19 yrs. Yes Yes. However, the utility ofthe Observing dimension inchildren and adolescentswithout experience inmeditation is controversial

Note: MAAS-A, Mindful Attention Awareness Scale-Adolescent; MAAS-C, Mindful Attention Awareness Scale-Children; CAMM, Child and Adolescent Mindfulness Measure; CHIME-A, Compre-hensive Inventory of Mindfulness Experiences-Adolescent; EAP, Escala de Atención Plena en el Ámbito Escolar; FFMQ-A, Five Facet Mindfulness Questionnaire-Adolescent.

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onsistency and a one-factor solution, and that scores on theAAS-C are associated with indicators of well-being across

everal domains (Lawlor et al., 2014).Pallozzi et al. (2016) examined several characteristics of

easures of mindfulness such as readability, difficulty oftems, and response format. They concluded that, althoughhe six response options of the MAAS is higher than the cut-oint of five response options that is preferable for childrennd adolescents, the MAAS-A offers a suitable option fordolescent populations. Its unidimensional factor structureas been replicated in adolescent populations. In addition,t has a high proportion of concrete items (80%) and ade-uate readability. Despite these positive characteristics,hese authors also recommended that the instruction setor the MAAS-A should be revised to increase readability forhildren and adolescents.

hild and adolescents mindfulness measureGreco et al., 2011)

he CAMM was the first, and one of the most widely usedeasures, developed to assess mindfulness skills in children

nd adolescents from ages 9 to 18. It is a 10-item self-reportcale that measures mindfulness as a unidimensional con-truct defined as present-centered awareness and the abilityf being non-judgmental toward one’s inner experiences.espondents have to decide how often each statement isrue for them using a five-point Likert type scale rangingrom 0 (never true) to 4 (always true) (e.g., ‘‘I tell myselfhat I shouldn’t feel the way I’m feeling,’’ ‘‘I stop myselfrom having feelings that I don’t like.’’). The scores are com-uted by inverting all the items and summing the responses,o the total score ranges between 0 and 40.

For the development of the CAMM, Greco et al. (2011)dapted the Kentucky Inventory of Mindfulness Skills (KIMS;aer et al., 2004) to youth samples through a series oftudies. The KIMS consists of 39 items developed from an ini-ial pool of 77 items designed to measure four mindfulnessimensions: observing, describing, acting with awareness,nd accepting without judgment. In Study 1, Greco et al.elected 25 items from the observing, acting with aware-ess, and accepting without judgment facets of the KIMS andxcluded the items from the describing dimension becausehey considered that this dimension presented understand-ng difficulties for children. In Study 2, an exploratory factornalysis supported a two-factor structure composed of act-ng with awareness and accepting without judgment. Thebserving facet was dropped from the scale due to its con-radictory nature in youth. It might be either maladaptive-- characterized by judgment and reactivity --- or adaptive ---haracterized by openness and acceptance. In Study 3, theemaining 16-items were examined with a confirmatory fac-or analysis and reduced to a 10-item questionnaire with aingle-factor structure of mindfulness as a present-centeredwareness and non-judgmental stance toward internal expe-iences.

The single-factor solution has been confirmed by several
tudies. For instance, Kuby et al. (2015) found this was theest model in adolescent boys and girls separately. However,lternative structures have also been proposed. As an exam-le, in the Netherlands, Bruin et al. (2013) found evidence
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or the one-factor model, but also for a two-factor model.he latter was examined independently in two samples ofchool-age children and adolescents. Both samples shared aommon factor of present moment, non-judgmental aware-ess. However, differences were found for the second factor,hich was the suppression or avoidance of thoughts in chil-ren and the distractibility or difficulty of paying attentionn adolescents. This finding suggests that the CAMM mighteasure mindfulness differently depending on the age and

he developmental stage.The 10-item version of the CAMM has been widely

sed. The studies that examined its psychometric proper-ies reveal adequate internal consistency with Cronbach’slphas ranging from .70 to .85, and good convergent andiscriminant validity (Pallozzi et al., 2016). For instance,reco et al. (2011) found positive correlations of theAMM with measures of quality of life, academic com-etence, and social skills and negative correlations withomatic complaints, internalizing symptoms, and external-zing behavioral problems. The CAMM was also used toxamine changes in mindfulness after mindfulness trainingSinclair & Goodfriend, 2013). Recently, Vickery and Dorjee2016) employed the CAMM to measure changes in mind-ulness scores among children from 7 to 9 years after the‘Paws b program’’ (2015), an 8-week mindfulness-basedntervention. They did not find changes in the CAMM scoresre-to-post intervention, which might be explained by thege of the sample.

The CAMM has also been adapted to other countries, andost of the validation studies support a one-factor struc-

ure, such as the Portuguese version (Cunha et al., 2013).inas et al. (2015) examined a Catalan version of the scaleage = 11---16). Exploratory and confirmatory factor analysesupported a 10-item model with one factor. A sample items: ‘‘Em sento malament per tenir sentiments que no tenenentit’’. The psychometric properties were adequate andimilar to the original version (Greco et al., 2011). The inter-al consistency was adequate (˛ = .80), and the measureas positively correlated with measures of social, fam-

ly, academic and emotional self-concept; effortful control,ctivation control, and inhibition control. The test---retesteliability one year later was r = .47, which suggests moder-te stability of the measure.

The Spanish version of the CAMM was preliminarily trans-ated and examined by Turanzas Romero (2013) in a sampleged between 12 and 15 years. His results supported awo-factor structure composed of (1) awareness and atten-ion, and (2) acceptance. However, as the latter was onlyomposed by 2 items, he suggested using the scale as aingle-factor structure. The psychometric properties of thisersion were adequate (e.g., ˛ = .78). The scale was pos-tively correlated with academic achievement and otherindfulness measures (the EAP; León, 2008).The CAMM has some advantages for use with children. It is

hort (15---20 min), straightforward, with easy-to-understandanguage, and its correction is simple. According to Pallozzit al.’s (2016) analyses, it has a suitable readability index.owever, it has some limitations. First, the original CAMM

tems are reverse-scored. Recent research suggests thateverse scores might not measure the same as directtems (Reise & Waller, 2009). Second, 80% of the itemsre abstract, which can complicate their comprehension

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Dispositional mindfulness in children and adolescents

(Pallozzi et al., 2016). Third, there is still not enough evi-dence to conclude whether the questionnaire measures thesame at different ages and developmental levels. Finally,research on the Spanish version of the questionnaire is onlybeginning and there is need for additional studies that exam-ine the CAMM as a measure of intervention outcome.

The five-facet mindfulness questionnaire(FFMQ; Baer et al., 2006)

Baer et al. (2006) combined all the items from five question-naires (the MAAS, Brown & Ryan, 2003; the Freiburg Mind-fulness Inventory, Buchheld, Grossman, & Walach, 2001; theKIMS, Baer et al., 2004; the Cognitive and Affective Mindful-ness Scale, Feldman, Hayes, Kumar, Greeson, & Laurenceau,2004; The Mindfulness Questionnaire, Chadwick, Hember,Mead, Lilley, & Dagnan, 2005) into a single data set andused exploratory factor analysis to examine the structure ofthis combined item pool. They found a five-facet structure,which then obtained support from confirmatory factor anal-ysis. The five facets were named: Observing (attending to ornoticing internal or external experiences), Describing (usingwords to describe inner experience), Acting with awareness(attending to the present moment), Non-judging of innerexperience (the non-evaluation of thoughts and feelings),and Non-reactivity to inner experience (the ability to letthoughts and feelings come and go, without getting caughtup in them). Thus, the proposed facets are very similar tothose included in the KIMS.

These researchers developed the Five-Facet MindfulnessQuestionnaire (FFMQ) with the 39 items of the initial poolthat presented minimum loadings of .40 on one factor andwith a difference of at least .20 between the highest andnext highest factor loading. Items are responded on a five-point response format, ranging from 1 (never or rarely true)to 5 (very often or always true). The authors found that thestructure that best fits the data was a 4-factor hierarchicalstructure consisting of a second-order factor (Mindfulness)that explained all lower level factors except for Observing.However, in a later study in a sample of experienced med-itators, Baer et al. (2008) confirmed a structure with onesecond-order factor (Mindfulness) that accounted for thefive first-order factors of the FFMQ. Since then, various stud-ies have found that the observing dimension of mindfulnesscould be maladaptive in samples of non-meditators and thatit correlates negatively with other dimensions of mindful-ness (Royuela-Colomer & Calvete, 2016; Sugiura, Sato, Ito,& Murakami, 2012).

The FFMQ has been translated into several languagesin several countries (e.g., China: Deng, Liu, Rodriguez, &Xia, 2011; Italy: Giovannini et al., 2014; Japan: Sugiuraet al., 2012; Norway: Dundas, Vøllestad, Binder, & Sivertsen,2013; Spain:Cebolla et al., 2012). The FFMQ has been usedwith adolescents in various studies (Ciesla, Reilly, Dickson,Emanuel, & Updegraff, 2012).

Recently, the FFMQ has been adapted to adolescentsaged between 13 and 19 years in Spain (Royuela-Colomer
& Calvete, 2016). Sample items of the Spanish versionare: ‘‘Soy bueno en encontrar palabras para describirmis sentimientos’’ (Describing), ‘‘Me distraigo fácilmente’’(reverse item, Acting with awareness), ‘‘Pienso que
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63

lgunas de mis emociones son malas o inapropiadas, yue no debería sentirlas’’ (reverse item, Non-judging),‘Cuando tengo pensamientos o imágenes mentales nega-ivas, me tranquilizo rápidamente’’ (Non-reactivity), and‘Presto atención a sensaciones como el viento en mi cabello

el sol sobre mi cara’’ (Observing). Confirmatory factornalyses supported the five-factor correlated model of theFMQ-A. However, no support was found for hierarchicalodels of the FFMQ. Test---retest was adequate, suggesting

hat individual differences are stable over time in adoles-ents. Cronbach’s alpha coefficients ranged between .75Non-reactivity) and .91 (Describing). Consistent with previ-us studies with adults, inter-correlations among the facetsndicated that Observing was negatively correlated withon-judging and Acting with awareness (e.g., Sugiura et al.,012). As mentioned above, it has been suggested thatbserving acts differently compared to the other mind-ulness facets. Baer et al. (2006, 2008) suggested thatndividuals with no meditation experience observe theireelings or actions while judging them at the same time,hus concluding that observing may be a maladaptive factorn non-meditating samples. Furthermore, Royuela-Colomernd Calvete (2016) found that, in contrast to the beneficialffects of other mindfulness facets, observing predicted anncrease in depressive symptoms by increasing ruminativeesponses in adolescents.

Pallozzi et al. (2016) found that the adult version ofhe FFMQ has a Reading Grade Level of 9 according to theale-Chall index, which is influenced by presence of diffi-ult words. However, they did not examine the difficulty andeadability of the FFMQ-A, which includes several changes intems to make it adequate for adolescents. In their review,allozzi et al. (2016) found that the FFMQ was one of theongest questionnaires together with the KIMS. However, ashe FFMQ can be completed in 30 min of focused work, theyonsidered the FFMQ manageable for adolescents, unless its included in a larger battery of questionnaires. Recently,

short version of the FFMQ with only 24 items has beeneveloped (Bohlmeijer, Peter, Fledderus, Veehof, & Baer,011). Future research should examine the properties of thisersion in children and adolescents.

he comprehensive inventory of mindfulnessxperiences-adolescents (CHIME-A; Johnsont al., 2016)

ased on the German mindfulness adult scale, the Com-rehensive Inventory of Mindfulness Experiences (CHIME;ergomi, Tschacher, & Kupper, 2013), Johnson et al. (2016)onducted a series of studies to adapt the CHIME to ado-escents aged 12---14 years. The CHIME-A is composed of5 items divided into 8 factors: (1) Awareness of inter-al experiences (awareness of emotions); (2) Awarenessf external experiences (awareness of environment);3) Acting with awareness (awareness of present moments opposed to being caught up in thinking about theast/future); (4) Accepting and non-judgmental orientation
self-kindness toward mistakes and perceived weaknesses);5) Decentering and non-reactivity (ability to step backrom difficult thoughts and emotions and not reactmmediately); (6) Openness to experience (capacity to allow

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he presence of difficult emotions and thoughts); (7) Rela-ivity of thoughts (recognition of thoughts as transient andubjective); and (8) Insightful understanding (recognitionhat subjective interpretation of situations can create orompound difficulty). Sample items are: ‘‘I try to avoid emo-ional pain as much as possible’’ or ‘‘I try to stay busy toeep certain thoughts or feelings out of my mind’’. Respon-ents rate each statement on a five-point scale ranging from

(Never) to 5 (Always).In their adaptation, the authors first examined how

ell the full adult measure (37-items) was understood byouth. Considering expert recommendations, the languageas simplified, Likert descriptors were re-arranged and the

everse-scored items were clustered all together at the endf the scale. Following the feasibility examination, severalxploratory factor analysis and confirmatory factor anal-ses were conducted, and the data supported a 25-itemodel divided into the above-mentioned factors. This model

ad excellent model fit indices and adequate internal con-istency except for the Openness to experience subscale˛ = .55). The authors did not find good temporal stability, asnly three of the facets had a significant test---retest corre-ation: Acting with awareness, Decentering/non-reactivity,nd Openness.

Johnson et al. (2016) examined the external validity ofhe questionnaire. For the convergent validity, the authorsound that the CHIME-A was positively correlated with theAMM (Greco et al., 2011), and measures of well-being.iscriminant validity was supported by negative correla-ions with measures of difficulties in emotion regulation,erfectionism, negative affect, weight and shape concerns,epression, and anxiety.

To our knowledge, the CHIME-A has only been examinedy Johnson et al. (2016) and it has some limitations. First, itas only been analyzed in the age group of 12---14 years, andifferent results may require further examination. In addi-ion, the scale is a modification of an adult version and theimplification of the vocabulary to youthful language mightiss some of the original meaning. Moreover, contrary to

he adult version in which the eight factors were explainedy a broader second-order factor, results from the CHIME-Aid not support a hierarchical structure and the subsequentverall mindfulness score. Despite the limitations, this scales promising and needs to be tested cross-culturally, in otherreas, and pre and post mindfulness-based interventions.

scala de Atención Plena en el Ámbito EscolarEAP; León, 2008)

he Escala de Atención Plena en Ámbito Escolar (EAP;eón, 2008) is the first scale developed in Spanish to assessindfulness in youth aged 12---16 years. The EAP measuresindfulness as the state of being focused in the presentoment consciously, observing in a contemplative way all

he perceptions and sensations as experienced in the presentoment, without judging them. The scale is composed of

2 items, and responses are rated on a Likert-type format
anging from 1 (never) to 5 (always). Sample items are:‘Cuando me ducho, siento como el agua cae por mi cuerpo’’nd ‘‘Me doy cuenta rápidamente cuando algo me producelegría’’.
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The scale was developed in an attempt to measure theelationship between mindfulness and academic achieve-ent. León, Martín, García and Felipe (2008) examined

preliminary 20-item scale in a sample of children aged2---15 years. After the results of a factor analysis, thecale was reduced to 15 items, and a second study by León2008) supported a 12-item model. Both studies supported

3-factor structure composed of kinesthetic attention (thebility to be aware of movement and motor actions of theody), external attention (the ability to direct attentiono the external events of one’s surroundings), and internalttention (the ability to change and focus attention inward,oward intellectual aspects, the world of the ideas, emo-ions, and feelings).

The study of the psychometric properties of the scaleLeón, 2008) revealed adequate internal consistency forhe entire scale (˛ = .84), as well as for Kinesthetic atten-ion (˛ = .74), and External attention (˛ = .80). However,he consistency was limited for Internal attention (˛ = .66).he test---retest reliability of the first version of the scale20-item) was r = .78, which indicated high stability after a-week interval (León et al., 2008).

The EAP is simple and short, and it uses child-friendly lan-uage. Moreover, there are no reverse items, which is goodor children and adolescents. However, we should considerome limitations of the scale. First, it has only been vali-ated in two studies. There are no studies that used the scalen other samples, contexts, or as an intervention outcomeeasure. Due to its limited use, there is not enough infor-ation about the psychometric properties of the scale, andore information is needed on convergent and discriminant

alidity, as well as on factor structure.

iscussion

n this paper, we have reviewed the available self-reporteasures to assess dispositional mindfulness in children

nd adolescents, with special emphasis on the measures inpanish. The review indicates that there are only three ques-ionnaires adapted to Spanish, the MAAS-A, the CAMM, andFMQ-A, and one questionnaire originally developed in Span-sh, the EAP. In addition, there is another questionnaire innglish available for adolescents, the CHIME-A, which, likelyue to its recent development, has not yet been validatedn Spanish.

From the psychometric point of view, most of thesenstruments have suitable properties for use with childrennd adolescents. For example, the internal consistency ofhe scales and subscales is generally good, with the excep-ion of the Openness to experience subscale of the CHIME-AJohnson et al., 2016) and the Internal attention subscalef the EAP (Leon et al., 2008). Only two of the reviewednstruments (the FFMQ-A and the CAMM) provide data ofoncurrent validity for the Spanish versions, showing theirositive association with other measures of mindfulnesse.g., Royuela-Colomer & Calvete, 2016; Turanzas Romero,013). Regarding the predictive validity of the versions in
panish, only the MAAS-A (Calvete et al., 2014) and theFMQ-A (Royuela-Colomer & Calvete, 2016) have obtainedegative associations with various psychological problems.n addition, the scores of the CAMM (Turanzas Romero, 2013)

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and the EAP (Leon et al., 2008) have been found to beassociated with academic performance, indicating their use-fulness in educational settings. Overall, the data suggestthat further research is still needed on measures of mind-fulness in Spanish. For most of them, the evidence is stillscarce and has been obtained very recently.

As mentioned above, although the consistency of most ofthe measures is appropriate, some of them can be improvedfrom the point of view of reading and understanding by chil-dren and adolescents. The analysis by Pallozzi et al. (2016)indicates that two of the measures (the MAAS-A and FFMQ)exceed the cut-off of 5 response options for items, and allother measures have 5-point response formats. Therefore,in the future, the functioning of some of these measuresshould be examined with easier response scales, such as, forexample, only three options (never, sometimes, and often),which can be more understandable for younger people.

Some of the self-report measures examined include itemswith abstract ideas that can be difficult, especially for chil-dren. It is very important to make an effort to adapt thelanguage. For example, in the version for adolescents of theFFQM, some items were written in a friendlier way (e.g.,‘‘Me critico cuando tengo ideas absurdas’’ instead of ‘‘Idisapprove of myself when I have irrational ideas; Royuela-Colomer & Calvete, 2016). Moreover, in general, a detailedreading reveals that the items of the dimensions of Act-ing with awareness tend to be simpler than items of othersubscales.

One of the most important aspects to consider whenselecting a measure of mindfulness refers precisely to thedimensions of mindfulness included in the measure. The twomeasures most frequently used with children and adoles-cents, the MAAS-A and the CAMM, assess a single dimension.This unique dimension includes the aspect of attention oracting with awareness, although the CAMM includes twoitems related to acceptance or not judging. In the case ofEAP, although the items are organized into three subscales,all they refer to types of attention.

We think that measures based exclusively on the atten-tion component are limited. Although there is no consensuson the dimensions of dispositional mindfulness and howmany there are, the evidence obtained from several fac-tor analyses suggests that dispositional mindfulness does notconsist of a single dimension. The evaluation of the differentfacets of mindfulness is necessary to know its protective andbeneficial role in the field of various psychological problems.Moreover, mindfulness-based interventions should exam-ine to what extent the various dimensions of mindfulnessimprove as a result of the intervention and the potentialmediating role of these improvements in behavioral andemotional changes displayed by participants in the inter-ventions. The results of this analysis would provide keyinformation about which meditation training componentsshould be strengthened (Kazdin, 2007) and would informtheory on mindfulness.

From this point of view, we consider that the FFMQ-A provides adequate information on various dimensions ofmindfulness. The short version of the FFMQ (Bohlmeijer
et al., 2011) should be examined in children and ado-lescents. Furthermore, of the dimensions assessed by theFFMW, the dimension of Observing is probably unneces-sary because the available evidence to date suggests that
TdP

65

his dimension can reflect a maladaptive characteristic inndividuals who do not practice meditation regularly. Forxample, in the study of Royuela-Colomer and Calvete2016), observing was associated with a more ruminativetyle and depression. Although the debate on the dimen-ionality of the construct of mindfulness is not specific tohildhood and adolescence as it is still unresolved in adults,e think that it should also be considered at these develop-ental stages.Moreover, in relation to the above, another limitation

bserved in the available research on measures of mind-ulness for children and adolescents is the lack of studiesith a developmental perspective. It is important to exam-

ne the development of the construct and its dimensionsn different age groups. Some of the reviewed studies sug-est that the factor structure may vary depending on thege of the participants (Johnson et al., 2016). Moreover,uring middle childhood, children develop and consolidateognitive thinking. They also acquire self-awareness andmpathy, and therefore, the study of the development ofispositional mindfulness helps understand the developmentf meta-cognition and self- regulation (Lawlor et al., 2014).

We have not included in this review some adult mindful-ess measures that have been used among adolescents. As anxample, Lau and Hue (2011) employed the Freiburg Mind-ulness Inventory (FMI; Buchheld et al., 2001), as an outcomeeasure for an intervention. However, most of the stud-

es have been either correlational or intervention, and haveot analyzed the internal structure and other psychometricroperties of these questionnaires in youth. Therefore, wexcluded them from our review.

Finally, recently, other theoretically-related Buddhistoncepts such as compassion, altruism, and social respon-ibility have been incorporated into the mindfulness fieldRau & Williams, 2015). Thus, the assessment of mindfulnessn children and adolescents should be extended to includehese aspects.

onclusions

esearch on the dispositional mindfulness measures inhildren and adolescents is promising. Most of the ques-ionnaires have suitable psychometric properties. However,ome improvements are still needed to better adapt theseeasures to youth. While most of the measures refer toindfulness as a single factor, we now need to turn to the

xamination of the different dimensions of mindfulness. Thisill help to achieve a better understanding of the underlyingechanism of mindfulness-based interventions, as well as to

xamine the developmental perspective of mindfulness.

onflict of interest

he authors declare that they have no conflict of interest.

cknowledgements

his research was supported by a grant from the Ministerioe Economía y Competitividad (Spanish Government, Ref.SI2015-68426-R).

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eferences

ndrei, F., Vesely, A., & Siegling, A. B. (2016). An Examinationof Concurrent and Incremental Validity of Four MindfulnessScales. Journal of Psychopathology and Behavioral Assessment,http://dx.doi.org/10.1007/s10862-016-9546-x

aer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mind-fulness by self-report: The Kentucky Inventory of MindfulnessSkills. Assessment, 11, 191---206. http://dx.doi.org/10.1177/1073191104268029

aer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L.(2006). Using self-report assessment methods to explore facetsof mindfulness. Assessment, 13(1), 27---45. http://dx.doi.org/10.1177/1073191105283504

aer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J.,Sauer, S., et al. (2008). Construct validity of the Five FacetMindfulness Questionnaire in meditating and non-meditatingsamples. Assessment, 15, 329---342. http://dx.doi.org/10.1177/1073191107313003

enn, R. (2004). Modified Mindful Attention Awareness Scale.Unpublished raw data.

ergomi, C., Tschacher, W., & Kupper, Z. (2013). Measur-ing mindfulness: First steps towards the development ofa comprehensive mindfulness scale. Mindfulness, 4, 18---32.http://dx.doi.org/10.1007/s12671-012-0102-9

lack, D. S., Sussman, S., Johnson, C. A., & Milam, J. (2012). Psy-chometric assessment of the Mindful Attention Awareness Scale(MAAS) among Chinese adolescents. Assessment, 19(1), 42---52.http://dx.doi.org/10.1177/1073191111415365

ohlmeijer, E., Peter, M., Fledderus, M., Veehof, M., & Baer,R. (2011). Psychometric properties of the five facet mind-fulness questionnaire in depressed adults and developmentof a short form. Assessment, http://dx.doi.org/10.1177/1073191111408231

risbon, N. M., & Lowery, G. A. (2011). Mindfulness and lev-els of stress: A comparison of beginner and advanced hathayoga practitioners. Journal of Religion and Health, 50(4),931---941.

rown, K. W., & Ryan, R. M. (2003). The benefits of beingpresent: Mindfulness and its role in psychological wellbeing.Journal of Personality and Social Psychology, 84, 822---848.http://dx.doi.org/10.1037/0022-3514.84.4.822

rown, K., West, A., Loverich, T., & Biegel, G. (2011). Assessingadolescent mindfulness: Validation of an Adapted MindfulAttention Awareness Scale in adolescent normative and psychi-atric populations. Psychological Assessment, 23(4), 1023---1033.http://dx.doi.org/10.1037/a0021338

ruin, E. I., Zijlstra, B. J. H., & Bögels, S. M. (2013). The meaningin mindfulness in children and adolescents: Further validationof the child and adolescent mindfulness measure (CAMM) intwo independent samples from The Netherlands. Mindfulness,5, 422. http://dx.doi.org/10.1007/s12671-013-0196-8

uchheld, N., Grossman, P., & Walach, H. (2001). Measuring mind-fulness in insight meditation (Vipassana) and meditation-basedpsychotherapy: The development of the Freiburg Mindful-ness Inventory (FMI). Journal for Meditation and MeditationResearch, 1(1), 11---34.

alvete, E. (2017). Mindfulness-Based Intervention in School: Chal-lenges for Future Research. ISSBD Bulletin, 2(70), 17---19.

alvete, E., Sampedro, A., & Orue, I. (2014). Propiedades psi-cométricas de la versión espanola de la ‘‘Escala de atención yconciencia plena para adolescentes’’ (Mindful Attention Aware-ness Scale-Adolescents) (MAAS-A). Psicología Conductual, 22(2),277.

alvete, E., Orue, I., & Sampedro, A. (2016). Does the actingwith awareness trait of mindfulness buffer the predictiveassociation between stressors and psychological symptoms


in adolescents? Personality and Individual Differences,http://dx.doi.org/10.1016/j.paid.2016.09.055 (in press)

ebolla, A., García-Palacios, A., Soler, J., Guillen, V., Banos, R.,& Botella, C. (2012). Psychometric properties of the Spanishvalidation of the Five Facet Mindfulness Questionnaire (FFMQ).European Journal of Psychiatry, 26(2), 118---126.

hadwick, P., Hember, M., Mead, S., Lilley, B., & Dagnan, D. (2005).Responding mindfully to unpleasant thoughts and images: Reli-ability and validity of the Mindfulness Questionnaire. As cited inRA Baer, GT Smith, & Allen, KB (2004). Assessment of mindful-ness by self-report: The Kentucky Inventory of Mindfulness Skills.Assessment, 11, 206---216.

iesla, J. A., Reilly, L. C., Dickson, K. S., Emanuel, A. S., & Upde-graff, J. A. (2012). Dispositional Mindfulness moderates theeffects of stress among adolescents: Rumination as a media-tor. Journal of Clinical Child & Adolescent Psychology, 41(6),760---770. http://dx.doi.org/10.1080/15374416.2012.698724

unha, M., Galhardo, A., & Pinto-Gouveia, J. (2013). Child andadolescent mindfulness measure (CAMM): estudo das caracterís-ticas psicométricas da versão portuguesa. Psicologia: Reflexãoe Crítica, 26(3), 459---468.

e Bruin, E. I., Zijlstra, B. J., Van de Weijer-Bergsma, E., & Bögels,S. M. (2011). The Mindful Attention Awareness Scale for Ado-lescents (MAAS-A): Psychometric properties in a Dutch sample.Mindfulness, 2(3), 201---211. http://dx.doi.org/10.1007/s12671-011-0061-6

eng, Y., Liu, X., Rodriguez, M., & Xia, C. (2011). TheFive Facet Mindfulness Questionnaire: Psychometric prop-erties of the Chinese version. Mindfulness, 2, 123---128.http://dx.doi.org/10.1007/s12671-011-0050-9

undas, I., Vøllestad, J., Binder, P. E., & Sivertsen, B. (2013).The Five Factor Mindfulness Questionnaire in Norway. Scandi-navian Journal of Psychology, 54, 250---260. http://dx.doi.org/10.1111/sjop.12044

eldman, G. C., Hayes, A. M., Kumar, S. M., Greeson, J. M., & Lau-renceau, J. P. (2004). Development, factor structure, and initialvalidation of the Cognitive and Affective Mindfulness Scale.(Unpublished manuscript).

elver, J. C., Celis-de Hoyos, C. E., Tezanos, K., & Singh, N.N. (2016). A systematic review of mindfulness-based interven-tions for youth in school settings. Mindfulness, 7(1), 34---45.http://dx.doi.org/10.1007/s12671-015-0389-4

iovannini, C., Giromini, L., Bonalume, L., Tagini, A., Lang, M.,& Amadei, G. (2014). The Italian Five Facet Mindfulness Ques-tionnaire: A contribution to its validity and reliability. Journalof Psychopathology and Behavioural Assessment, 36, 415---423.http://dx.doi.org/10.1007/s10862-013-9403-0

reco, L. A., Baer, R. A., & Smith, G. T. (2011). Assessing mindful-ness in children and adolescents: Development and validation ofthe Child and Adolescent Mindfulness Measure (CAMM). Psycho-logical Assessment, 23(3), 606---614. http://dx.doi.org/10.1037/a0022819

rossman, P. (2011). Defining mindfulness by how poorly I think I payattention during everyday awareness and other intractable prob-lems for psychology’s (re)invention of mindfulness: Commenton Brown et al. Psychology Assessment, 23(4), 1034---1040.http://dx.doi.org/10.1037/a0022713

ermann, F., Larøi, F., Bondolfi, G., Billieux, J., d’Argembeau,A., & Zermatten, A. (2009). Mindful Attention Aware-ness Scale (MAAS): Psychometric properties of the Frenchtranslation and exploration of its relations with emotion reg-ulation strategies. Psychological Assessment, 21, 506---514.http://dx.doi.org/10.1037/a0017032

ohnson, C., Burke, C., Brinkman, S., & Wade, T. (2016). Develop-

The Comprehensive Inventory of Mindfulness Experiences-Adolescents (CHIME-A). Psychological Assessment.

dx.doi.org/10.1007/s10862-016-9546-x

dx.doi.org/10.1177/1073191104268029

dx.doi.org/10.1177/1073191104268029

dx.doi.org/10.1177/1073191105283504

dx.doi.org/10.1177/1073191105283504

dx.doi.org/10.1177/1073191107313003

dx.doi.org/10.1177/1073191107313003

dx.doi.org/10.1007/s12671-012-0102-9

dx.doi.org/10.1177/1073191111415365

dx.doi.org/10.1177/1073191111408231

dx.doi.org/10.1177/1073191111408231





























dx.doi.org/10.1037/0022-3514.84.4.822

dx.doi.org/10.1037/a0021338

dx.doi.org/10.1007/s12671-013-0196-8
























































































dx.doi.org/10.1016/j.paid.2016.09.055













































































dx.doi.org/10.1080/15374416.2012.698724



























dx.doi.org/10.1007/s12671-011-0061-6

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Kallapiran, K., Koo, S., Kirubakaran, R., & Hancock, K. (2015).Review: Effectiveness of mindfulness in improving mentalhealth symptoms of children and adolescent: A meta-analysis. Child and Adolescent Mental Health, 20(4), 182---194.http://dx.doi.org/10.1111/camh.12113

Kazdin, A. E. (2007). Mediators and mechanisms of change inpsychotherapy research. Annual Review of Clinical Psychol-ogy, 3(1), 1---27. http://dx.doi.org/10.1146/annurev.clinpsy.3.022806.091432

Kuby, A. K., McLean, N., & Allen, K. (2015). Validation of theChild and Adolescent Mindfulness Measure (CAMM) with non-clinical adolescents. Mindfulness, 6, 1448. http://dx.doi.org/10.1007/s12671-015-0418-3

Lau, N. S., & Hue, M. T. (2011). Preliminary outcomes ofa mindfulnessbased program for Hong Kong adolescents inschools: Wellbeing, stress and depressive symptoms. Inter-national Journal of Children’s Spirituality, 16, 315---330.http://dx.doi.org/10.1080/1364436X.2011.639747

Lawlor, M. S., Schonert-Reichl, K. A., Gadermann, A. M., & Zumbo,B. D. (2014). A Validation Study of the Mindful Attention Aware-ness Scale Adapted for Children. Mindfulness, 5(6), 730---741.http://dx.doi.org/10.1007/s12671-013-0228-4

León, B. (2008). Atención plena y rendimiento académico en estudi-antes de ensenanza secundaria. European Journal of EducationPsychology, 1(3), 17---26.

León del Barco, B., Martín López, E., García Martín, A., & FelipeCastano, E. (2008). Estudio preliminar de la escala de atenciónplena ‘‘mindfulness’’ en el ámbito escolar. International Journalof Developmental and Educational Psychology, 1, 371---380. Doi:0214-9877.

Pallozzi, R., Wertheim, E., Paxton, S., & Ong, B. (2016). Trait mind-fulness measures for use with adolescents: A systematic review.Mindfulness, 1---16.

Rau, H. K., & Williams, P. G. (2015). Dispositional mindfulness:A critical review of construct validation research. Person-ality and Individual Differences, http://dx.doi.org/10.1016/j.paid.2015.09.035

67

eise, S. P., & Waller, N. G. (2009). Item response theory andclinical measurement. Annual Review of Clinical Psychology,5, 27---48. http://dx.doi.org/10.1146/annurev.clinpsy.032408.153553

oyuela-Colomer, E., & Calvete, E. (2016). Mindfulness facets anddepression in adolescents: Rumination as a mediator. Mindful-ness, 7, 1092. http://dx.doi.org/10.1007/s12671-016-0547-3

egal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002).Mindfulness-based cognitive therapy for depression. New York:Guilford Press.

inclair, C. M., & Goodfriend, W. (2013). Mindfulness in adolescents:Effects of single-session mindfulness meditation on anxiety anddepression. Journal of Psychological Inquiry, 18, 37.

oler Ribaudi, J., Tejedor, R., Feliu-Soler, A., Pascual Segovia, J. C.,Cebolla i Martí, A. J., Soriano, J., et al. (2012). Propiedades psi-cométricas de la versión espanola de la escala Mindful AttentionAwareness Scale (MAAS). Actas Espanolas de Psiquiatría, 40(1),18---25.

ugiura, Y., Sato, A., Ito, Y., & Murakami, H. (2012). Devel-opment and Validation of the Japanese Version of theFive Facet Mindfulness Questionnaire. Mindfulness, 3, 85---94.http://dx.doi.org/10.1007/s12671-011-0082-1

uranzas Romero, J. (2013). Adaptación transcultural de la escalaCAMM (Child and Adolescent Mindfulness Measure) y estudiopreliminar de sus características psicométricas Unpublishedmaster’s thesis. Valencia, Spain: Valencia International Univer-sity.

ickery, C. E., & Dorjee, D. (2016). Mindfulness training inprimary schools decreases negative affect and increases meta-cognition in children. Frontiers in Psychology, 6, 20---25.http://dx.doi.org/10.3389/fpsyg.2015.02025

inas, F., Malo, S., González, M., Navarro, D., & Casas, F.(2015). Assessing mindfulness on a sample of Catalan-Speaking
Spanish adolescents: validation of the catalan version of thechild and adolescent mindfulness measure. The Spanish Jour-nal of Psychology, 18, E46. http://dx.doi.org/10.1017/sjp.2015.48
dx.doi.org/10.1111/camh.12113

dx.doi.org/10.1146/annurev.clinpsy.3.022806.091432

dx.doi.org/10.1146/annurev.clinpsy.3.022806.091432

dx.doi.org/10.1007/s12671-015-0418-3

dx.doi.org/10.1007/s12671-015-0418-3

dx.doi.org/10.1080/1364436X.2011.639747

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EVIEW

ttachment-based compassion therapy

avier García-Campayoa,∗, Mayte Navarro-Gilb, Marcelo Demazroc

Department of Psychiatry Miguel Servet Hospital and the University of Zaragoza, SpainMasters in Mindfulness, University of Zaragoza, SpainUniversidad Federal de sao Paulo (UNIFESP), Sao Paulo, Brazil

eceived 12 September 2016; accepted 10 October 2016vailable online 18 November 2016

KEYWORDSCompassion;Attachment style;Protocol;Mindfulness

Abstract Compassion therapy is a third-generation psychotherapy that has been used inassociation with mindfulness in recent years. Similar to mindfulness protocols, a number ofcompassion protocols have been developed in the United States and Britain. As these countrieshave cultural characteristics and health systems that differ greatly from those of Spain, it wasnecessary to develop compassion protocols which were more suited to the Spanish situationand which could be administered to both general population and to medical and psychiatricpatients. This model is based on attachment styles, a psychoanalytical concept which describesthe relationship children develop with their parents, and which will influence the interpersonalrelationships and self-image they will eventually develop. This paper describes the scientificbasis for this model, the structure of the protocol, the scientific evidence and the train-ing programme for this model, which is the first such programme specifically developed forSpanish-speaking countries.© 2016 Published by Elsevier Espana, S.L.U. on behalf of Mindfulness & Compassion.

PALABRAS CLAVECompasión;Estilos de apego;Protocolo;Conciencia plena

Terapia de compasión

Resumen La terapia de compasión es una psicoterapia de tercera generación que se estáutilizando en los últimos anos de forma asociada al mindfulness. Existen varios protocolos deentrenamiento en compasión que, al igual que los protocolos de mindfulness, han surgido en

ornos culturales y sistemas sanitarios muy diferentes al nuestro. Ens que era necesario desarrollar un modelo de terapia de compasióntura, más adaptado a nuestro entorno sanitario y que pudiese serión general, sino también a pacientes con enfermedades psicológicasstá centrado en los estilos de apego, un concepto psicoanalítico que

que el nino desarrolla con sus padres y que influirá de forma decisiva

países anglosajones con enteste contexto consideramomás cercano a nuestra culaplicable no solo a la poblacy somáticas. Este modelo edescribe el tipo de relación

∗ Corresponding author.E-mail address: [email protected] (J. García-Campayo).

ttp://dx.doi.org/10.1016/j.mincom.2016.10.004445-4079/© 2016 Published by Elsevier Espana, S.L.U. on behalf of Mindfulness & Compassion.






Attachment-based compassion therapy 69

en el tipo de relación interpersonal que mantendrá de adulto con otras personas, así como enla imagen que desarrollará sobre sí mismo. En el artículo se describen las bases científicas delmodelo, la estructura del programa, los datos de evidencia y el proceso de formación en esteprotocolo, el primero autóctono desarrollado en países de habla hispana.© 2016 Publicado por Elsevier Espana, S.L.U. en nombre de Mindfulness & Compassion.

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A compilation of the first articles published in Spain onthe subject of mindfulness appeared in the Revista de Psi-coterapia (Journal of Psychotherapy) in 2006 (see Cebolla &Miró, 2006; García, 2006; Miró, 2006; Pérez & Botella, 2006;Santamaría, Cebolla, Rodríguez, & Miró, 2006; Simón, 2006).Mindfulness began to be used in the Spanish health system in2008 (García Campayo, 2008). It was found at the time thatmany of the protocols we were using, both for mindfulnessand compassion, were not well suited to the Spanish pop-ulation (García Campayo et al., 2014). The reason for thiswas partly due to transcultural differences, which includedaspects such as expressing emotions, the relationship withthe body and the relationship between healthcare profes-sionals and patients (García Campayo, Díez, & Sanmartín,2005) and partly because the Spanish system is very differ-ent from that found in the US, which is where most of theprotocols were created. Healthcare in Spain is mostly publicand free of charge, with a well-developed primary care sys-tem, while both aspects are of marginal importance in theUS. Lastly, with the exception of the Gilbert model, existingcompassion protocols are not considered as therapies for thetreatment of psychiatric illnesses and were not designed foruse with patients.

These reasons, and our experience as psychotherapists,convinced us of the need to develop structured protocolssuited to our cultural environment and out health systemthat could be used as psychotherapy. Moreover, we decidedto emphasize an aspect that we and many mental healthprofessionals have considered to be key to the therapeuticefficacy and which is clearly related to compassion: the indi-vidual attachment style. This is the reason for naming ourmodel attachment-based compassion therapy. Although anumber of aspects of attachment theory (particularly secureattachment as a base for compassion) already appear inthe theoretical foundations for other compassion models(Gilbert, 2015; Neff, 2012), this is the first time that a pro-gramme based on compassion makes profound use of it at thecore of the therapeutic process and as the base of the pro-gramme. The theoretical foundations on which this model isstructured are the following.

1. Attachment theory: Emotions are the main mentalphenomena associated with chronic stress. Emotionssuch as guilt, shame and hatred are considered partic-ularly destructive and are demonstrated to facilitate the
onset of different medical and psychiatric illnesses, asexplained by the Neuroinflammatory Theory (Akiyamaet al., 2000). By definition, emotions tend to arise ininterpersonal contexts. Attachment theory is one of the
tiot

theoretical constructs that best explains our way ofrelating with other people and, therefore, how emo-tions (positive and negative) arise in our relationshipsthroughout our lives. Knowing our attachment style andmodifying the aspects that cause distress will be associ-ated with reducing psychological distress. Our protocolaims to modify those styles by structuring a secureattachment style, one that is associated with reducingcriticism and anger towards ourselves and others, andwhich increases compassion.

. Contributions from other models of compassion andother therapies: No knowledge comes from nothing.Our model includes ideas from other compassion proto-cols (the structure of Paul Gilbert’s three brain circuitsand a number of practices that most protocols previ-ously took from tradition). It also includes techniquesfrom other cognitive and third-generation therapies(aspects of mindfulness taken from mindfulness-basedinterventions (García Campayo & Demarzo, 2015a), val-ues that comprise an essential technique of Acceptanceand Commitment Therapy and radical acceptance fromDialectical Behaviour Therapy).

. Contributions from tradition: As with other compassionprotocols, we have incorporated a number of prac-tices and theoretical foundations from tradition, such asTibetan Buddhism, but also from other religions, suchas Native American beliefs in which compassion plays apart, given that it is the common denominator in all ofthem. Logically, as is habitual in mindfulness and compas-sion therapy, any religious or cultural connotation hasbeen removed from these techniques and their efficacyhas been evaluated from a scientific perspective.

ttachment theory

rom an evolutionary perspective, it is accepted thatompassion (Goetz, Keltner, & Simon-Thomas, 2010) is keyo the care of offspring in species such as ours (and in mam-als in general) in which young are very vulnerable at birth

nd require the intensive care of adults for a long time inrder to survive. The concept of attachment, the capac-ty for affection and trust we feel for ourselves and othereople, arises in those first years of life.

The term attachment is a classic psychoanalyticaloncept developed by Bowlby (1969). This author asserted
hat when a child feels threatened, their attachment systems activated and they instinctively seek out the protectionf their parents. When the child habitually finds this pro-ection, they are said to develop a ‘‘secure attachment’’.

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owever, if this protection fails, the child develops a pro-ound insecurity in the relationship they have with theirarents (‘‘insecure attachment’’), which determines thatll their interpersonal adult relationships are based on mis-rust. This will also impact on the self-image that child willevelop. At such an age, a child cannot assimilate the ideahat their parents do not love them. What they think is thathey are doing something wrong, and that when they stopoing it, they will be loved again. Unfortunately, their entirehildhood is spent trying to understand why their parents doot love them without success.

Although some of Bowlby’s contributions are consideredutdated from different perspectives, the Attachment The-ry he described continues to be considered the modelo best describe the long-term dynamic of relationshipsetween humans. In summarized form, what it asserts ishat a child needs to develop a satisfactory stable and last-ng relationship during their early years with at least onearer in order for their psychological and emotional devel-pment to be adequate. When the child begins to crawl andalk away from their parents, they need the secure basef their known carers in order to explore their surroundingsnd return.

he multiple facets of attachment and care

are and attachment, both in primates and human beings,as become more complex throughout the course of evo-ution. In our experience, care and the attachment stylenclude the four following aspects that may or may notppear independently.

Protection and safety: This involves keeping children pro-tected from danger in order that they will feel safe andout of danger (which is the basis for survival of thespecies). It includes an aspect as important as comfort,i.e. calming the anguish of the child as it cries by meansof an embrace. If a person has not had this feeling of pro-tection and safety during their childhood, the feeling ofcontinuing alert to an undefined danger will predominate(a symptom common to any type of anxiety). Compassioncannot be possible if there is no basic notion of security.The insecure individual has to devote all their energy totheir survival (because they feel they are in danger), andwill have no energy left to feel sympathy for others.

Provision: This involves the offering of food, clothing,refuge and other material requirements for survival. Ifthis has not been received in childhood, the individualwill have difficulties in managing their primary needs.Consequently, they can be particularly thrifty and witha tendency to hoard (as was common in people whosechildhood coincided with an immediate post-war period)or unable to save and plan for the future, spending imme-diately and inappropriately any income they have (as hasbeen described in the children of poor African-Americanminorities in large US cities).

Expression of affection and validation of feelings: This
involves having received affection in a manner that isexplicit, identifiable and clearly expressed. If this is thecase, affection can be received and given spontaneouslyand trustingly. Otherwise, the expression and reception
J. García-Campayo et al.

of affection will be clearly limited by fear of being hurt(as occurs with certain types of neurosis) or by a totaldisconnect with our feelings (as occurs in certain peoplewho display obsessive or alexithymic traits). A key aspectof the expression of affection with which it is commonlyassociated is the validation of our feelings. This consistsof making a child aware that their feelings are valid,although they may be different (and not accepted or crit-icized by others). This will allow them to feel adequateand tranquil, despite feeling themselves to be differentfrom their social setting. Where parents have not offeredthe individual validation of their feelings, they will sys-tematically avoid conflict, will need continuous socialapproval and will self-criticize themselves systematicallyand destructively. We should always accept and validateour feelings.

Socialization and mentalization: Socialization involvesteaching a child the rules of the world and society inwhich they are going to live, and existing boundariesin order to minimize conflict with others and with thelaw. Overly permissive parents who are unable to setboundaries facilitate the development of children withpersonality disorders. Mentalization refers to assisting achild to understand the feelings of others, which is asso-ciated with better interpersonal relationships.

These four aspects are independent from each other,.e. they can develop adequately or inadequately, produc-ng multiple combinations. It is common for all four domainso fail at the same time (for instance, inadequate parentso not offer their child security, do not express affection tohem and invalidate them constantly, do not provide themith adequate food and clothing, and are unable to prop-rly socialize them or mentalize them). However, it is alsoommon for parents to offer some of these aspects: a sin-le mother may offer affection and validations, but maye unable to provide for them or offer safety owing to thenfavourable economic situation, and may be unable to setoundaries. A single father may offer safety and provideor the child, but may be unable to offer affection or vali-ation, and may not be a suitable model for socialization.or this reason, each of these domains should be dealt withndependently.

ttachment styles

artholomew and Horowitz (1991) developed a classifica-ion system for attachment styles in adulthood divided intoour main categories. It is thought that these styles, basedn our biographical experiences, define the way in whiche relate to other people. There is one secure attachment

tyle and three insecure attachment styles with differentharacteristics.

Secure attachment style: These are individuals who expe-rienced adequate, consistent and continuous care in theirchildhood. For this reason they developed great trust in
themselves and in others. The consequence is that theyfeel good about themselves and feel worthy of receivingaffection. They also feel comfortable about depending onother people, which allows them to ask others for held

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Attachment-based compassion therapy

and to receive it trustingly whenever they need it. Thereis a balance between needs for affection and personalautonomy.

• Preoccupied attachment style: This includes subjectswhose childhood experience is that of systematicallyvariable care, between an adequate response and a non-existent response (although there has never been abuse),with different intermediate levels of care. In other words,care has been erratic and unstable, and may or may nothave been received at random, generally depending onthe levels of medical or psychiatric conditions or adversecircumstances affecting the carer at any time. For exam-ple, this model has been described in the children ofparents suffering from bipolar disorder, with frequentbouts of depression or debilitating illnesses that appearwith great intensity in cyclical periods (e.g. migraine,rheumatic diseases, etc.). The consequence is that indi-viduals with this attachment style are overly responsiveto the opinion of others on whom they depend (given thatthey present a positive view of others), to the point offinding themselves trapped by the response of others. Asthey have a negative view of themselves, they renounceany of their desires or initiatives where these may enterinto conflict with the approval of others. They have verylow self-esteem, great dependence on others, high lev-els of subjective stress, and they focus on their negativethoughts and feelings. The continued preoccupation withbeing abandoned may trigger obsessional jealousy in sen-timental relationships.

• Dismissive attachment style: This is presented by individ-uals who have experienced childhood care in which thecarer’s response has systematically been inadequate ornon-existent. There were never periods of the adequatecare found in the preoccupied style. This style frequentlyoccurs when parents suffer from addictions, personalitydisorders or psychosomatic illnesses, such as hypochon-dria or acute somatization, which cause them to focus allof their attention on themselves, leaving no room for thecare of their children. Consequently, this group of indi-viduals develop total distrust in others and compensateby means of compulsive strategies through which theyhave had to place all their trust exclusively in themselves.Although their view of others is negative as a result oftheir childhood experiences, their image of themselvesis exaggeratedly positive as a result of their compulsiveself-reliant strategies. In their relationships with others,they show little understanding of the need for affection ofothers (which they consider unhealthy or a sign of weak-ness) because they learned to survive affectively on theirown and with help from nobody. This is one of the groupsof people who feel the greatest rejection for compassion.They are clearly ambitious for achievement, with littleneed for affection and few significant interpersonal rela-tionships, but with great emotional self-sufficiency, whichmeans they suffer little for this reason.

• Fearful attachment style: These are individuals who havereceived cold or violent care, based on rejection or pun-ishment. It is common when their parents are abusive,
alcoholic or substance-dependent, or present with acutepersonality disorders. These individuals develop a verynegative view both of others and of themselves. Abusedchildren cannot understand that their parents have a
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disorder; they only think that they are doing somethingwrong which merits punishment. The consequence of thisis that they spend their entire childhood trying to under-stand what it is that they are doing wrong and try tochange so that they will no longer be punished, althoughthey never succeed. As with the preoccupied style, theseindividuals present with low self-esteem and negativeaffect. Although they desire social contact, they inhibitthis desire because of their terrible fear of rejection.Their interpersonal adult relationships are characterizedby flight once they have reached a certain level ofintimacy. Personal relationships are always consideredsecondary to their work or professional goals.

The first descriptions of these classificationsBartholomew & Horowitz, 1991; Bowlby, 1969) led tohe hypothesis that they would be very closely associatedith the type of interpersonal relationship and communica-

ion with others. For instance, individuals with a negativeiew of others (dismissive and fearful attachment styles)ave learned that people will tend to ignore or rejectheir attempts to find support from others. Therefore,n comparison with people with a positive view of otherssecure and preoccupied attachment styles), they seekess support from others, which means that they tend noto reveal their feelings and their relationships are lessntimate. If the individual holds a negative self-opinionnd considers social relationships to be very importantpreoccupied), they will tend to do anything for their lovedne, renouncing everything of their own, including healthr money.

mportance of attachment styles

t is thought that 65 per cent of children present a securettachment style; the other 35 per cent present one of thensecure styles we have described (Prior & Glaser, 2006).he attachment style of parents predicts 75 per cent of theirhildren’s attachment style (Steele, Steele, & Fonagy, 1996).lthough there are other influences apart from attachment,hildren with a secure attachment style are more likely to beocially competent that their insecure counterparts. Theylso have greater ease in acquiring social skills, intellec-ual development and formation of a social identity. On thehole, they tend to be more successful on all levels thanhildren with insecure attachment styles.

In short, attachment styles modulate the image we havef ourselves and of others, and are therefore key to theelationship we have with ourselves and with others. Attach-ent style predicts feelings of guilt and shame towards

urselves and feelings of anger and mistrust towards oth-rs. Mindfulness and compassion therapy is key to clarifyingnd modifying the relationship we have with ourselves andthers, and therefore is closely related to attachment styles.

rotocol for attachment-based compassionherapy

s with other compassion protocols, our model is structurednto eight weekly sessions with a duration of approximatelywo hours. We have described our programme in greater

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etail in the book Mindfulness y Compasión: La Nueva Rev-lución [Mindfulness and Compassion: The New Revolution]García Campayo & Demarzo, 2015b). It describes the theo-etical foundations for the model, the structure in sessions,nd practices used in each session. Appendix I summarizeshe structure of the programme in sessions.

The efficacy of this programme has already been assessedn the general population and in healthcare professionals,nd two studies have already been conducted on them withavourable results that are due to be published in 2016. It haslso been evaluated in patients with different medical andsychiatric conditions. A randomized controlled trial (RCT)as recently been completed on patients suffering frombromyalgia in primary care (NCT02454244; Ethics Commit-ee: 15/0049) the result of which were also satisfactory andill be published in 2016. Another RCT will soon be con-ucted on patients with depression in primary care and isurrently in the design stage. The preliminary data from allf these studies are very promising and confirm the efficacyf the protocol both on final clinical results (pain, quality ofife and function), in measures of psychological well-being,nd in intermediate variables (compassion, positive affect,tc.).

Training in attachment-based compassion therapy iseing structured in the same way as other similar proto-ols. After a basic training programme, personal practice isecommended for a period of time. A training programme ishen given for application of the therapy (equivalent to theeacher training of other protocols) and, finally, the super-ision of the first two groups to which this therapy is applieds recommended using trainers experienced in the use of therogramme.

Training is systematically included in the Master’s degreen Mindfulness programme offered by the University ofaragoza, whose third edition is being completed this yearwww.masterenmindfulness.com). This training can also beeceived independently of the master’s programme throughpecific courses that we hold every three months, both in

weekly format and an intensive weekend course, takinglace at both at the University of Zaragoza and in citieshere there is demand (mindfulnessycompasiongarciacam-ayo.com).

onclusions

ttachment-based compassion therapy is a compassionrotocol that can also be used in both the general popu-ation and with medical and psychiatric conditions, and isdapted to the cultural setting and health systems of Latinountries (Iberia and Latin America). It is based on onef the fundamental psychological constructs that explainshe interpersonal relationships of individuals: attachmenttyles. The preliminary results of this intervention are veryromising and levels of acceptance and adherence of userss high. Unexpected effects are very few and of minor rele-ance. The versatility of the model, which can be used onoth populations with very acute depression and healthy
ndividuals, and the transdiagnostic component --- given thatt appears to be effective for depression, chronic pain andnxiety --- may facilitate its widespread use in the healthystems of Spain and Latin American countries.
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onflict of interest

he authors declare no conflict of interest.

ppendix I. Structure of the Universityf Zaragoza compassion protocolttachment-based compassion therapy

.1. Week 1

.1.1. Preparing ourselves for compassion. Kindttention.Theory:

The workings of our brain The reality of suffering: primary and secondary suffering What is and isn’t compassion?

Formal practice:

Compassionate breathing and compassionate body scan Compassionate coping with difficulties

Informal practice:

3-min compassionate practice Self-compassion diary Savouring and giving thanks

.2. Week 2

.2.1. Discovering our compassionate worldTheory:

Compassion and mindfulness Self-esteem and compassion Fear of compassion

Formal practice:

The figure of affect: connecting with basic affection Developing a safe place The compassionate action Identifying the figure of secure attachment

Informal practice:

The object that joins us to the world Diary of compassion practice What are we good at?

.3. Week 3

.3.1. Developing our compassionate worldTheory:

How compassion acts Effectiveness of compassion Self-criticism

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Formal practice:

- Developing the figure of secure attachment- Developing the compassionate voice

Informal practice:

- Writing a letter to a compassionate friend

A.4. Week 4

A.4.1. Understanding our relationship with compassionTheory:

- Attachment styles- Importance of these styles in everyday life

Formal practice:

- Becoming aware of our attachment style- Ability to receive affection: friend, indifferent person,

enemy

Informal practice:

- Letter to your parents

A.5. Week 5

A.5.1. Working on ourselvesTheory:

- Importance of affection towards ourselves and others

Formal practice:

- Showing affection to friends and indifferent people- Showing affection to ourselves- Reconciliation with our parents- Three positive aspects and three negative aspects of our

parents

Informal practice:

- The greatest display of affection (in general and from ourparents)

- The illusion of labels

A.6. Week 6

A.6.1. Advanced compassion (I): forgivenessTheory:

- Guilt and the importance of forgiveness

Formal practice:

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Forgiving yourself Asking others for forgiveness Forgiving others and showing compassion to enemies Showing forgiveness for the hurt caused by loved ones

(only for people with this experience) Recapitulation

Informal practice:

Compassion in everyday life Interdependence

.7. Week 7

.7.1. Advanced compassion (II): becoming your ownttachment figure and handling difficult relationshipsTheory:

Working in three periods Envy Usefulness of being our attachment figure Difficult people

Formal practice:

Working with envy Becoming our own attachment figure Handling difficult relationships

Informal practice:

Not taking anything personally Looking others in the eye and connecting with their suf-

fering

.8. Week 8

.8.1. Beyond compassion: equanimityTheory:

Equanimity How to keep up the practice of compassion for a lifetime

Formal practice:

Equanimity (I): We are all equal. Equanimity (II): The illusion of categories. Equanimity (III): Showing the world the gratitude we have

not been able to give back.

Informal practice:

Our values and their relation with compassion The cosmic attachment figure The tantric embrace

eferences

kiyama, H., Barger, S., Barnum, S., Bradt, B., Bauer, J., & Cole, G.M. (2000). Inflammation and Alzheimer’s disease. Neurobiologyof Aging, 21(3), 383---421.

http://refhub.elsevier.com/S2445-4079(16)30026-X/sbref0005

















7

B

B

C

G

G

G

G

G

G

G

G

M

N

P

P

S

S

4

artholomew, K., & Horowitz, L. M. (1991). Attachment stylesamong young adults: A test of a four-category model. Journalof Personality and Social Psychology, 61(2), 226.

owlby, J. (1969). Attachment and loss, vol. 1: Attachment. Lon-don: Hogarth Press.

ebolla, A., & Miró, M. T. (2006). Eficacia de la terapia cog-nitiva basada en la atención plena en el tratamiento de ladepresión. Revista de Psicoterapia, 66/67, 133---156. http://revistadepsicoterapia.com/eficacia-de-la- terapia-cognitiva-basada-en-la-atencion-plena-en-el-tratamiento-de-la-depresion.html

arcía, A. (2006). Mindfulness en la terapia dialéctico-comportamental. Revista de Psicoterapia, 66/67, 121---132.http://revistadepsicoterapia.com/mindfulness-en-la-terapia-dialectico-comportamental.html

arcía Campayo, J. (2008). La práctica del ‘‘estar atento’’ (mind-fulness) en medicina. Impacto en pacientes y profesionales.Atención Primaria, 40(7), 363---366.

arcía Campayo, J., & Demarzo, M. (2015a). Manual de mindful-ness. Curiosidad y aceptación. Barcelona: Siglantana.

arcía Campayo, J., & Demarzo, M. (2015b). Mindfulness y com-pasión. La nueva revolución. Barcelona: Siglantana.

arcía Campayo, J., Díez, M. A., & Sanmartín, A. O. (2005). Saludmental e inmigración en atención primaria. Madrid: Edikamed.

arcía Campayo, J., Navarro-Gil, M., Andrés, E., Montero-Marín, J.,López-Artal, L., & Demarzo, M. M. P. (2014). Validation of theSpanish versions of the long (26 items) and short (12 items) forms
of the Self- Compassion Scale (SCS). Health and Quality of LifeOutcomes, 12(4), 1---9.
ilbert, P. (2015). Terapia centrada en compasión. Bilbao: Descléede Brouwer.

S


oetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion:An evolutionary analysis and empirical review. Psychological Bul-letin, 136(3), 351---355.

iró, M. T. (2006). La atención plena (mindfulness) comointervención clínica para aliviar el sufrimiento y mejorar laconvivencia. Revista de Psicoterapia, 66/67, 31---76. http://revistadepsicoterapia.com/la-atencion-plena- mindfulness-como-intervencion-clinica-para-aliviar-el-sufrimiento-y-mejorar-la-convivencia.html

eff, K. (2012). Sé amable contigo mismo: El arte de la compasiónhacia uno mismo. Barcelona: ONIRO.

érez, M. A., & Botella, L. (2006). Conciencia plena (mindful-ness) y psicoterapia: Concepto, evaluación y aplicacionesclínicas. Revista de Psicoterapia, 66/67, 77---120. http://revistadepsicoterapia.com/conciencia- plena-mindfulness-y-psicoterapia-concepto-evaluacion-y-aplicaciones-clinicas.html

rior, V., & Glaser, D. (2006). Understanding attachment and attach-ment disorders: Theory, evidence and practice. Jessica KingsleyPublishers.

antamaría, M. T., Cebolla, A., Rodríguez, P. J., & Miró, M. T.(2006). La práctica de la meditación y la atención plena:Técnicas milenarias para padres del siglo XXI. Revista de Psi-coterapia, 66/67, 157---175. http://revistadepsicoterapia.com/la-practica-de-la-meditacion-y-la-atencion-plena-tecnicas-milenarias-para-padres-del-siglo-xxi.html

imón, V. (2006). Mindfulness y neurobiología. Revista de Psi-coterapia, 66/67, 5---30. http://revistadepsicoterapia.com/
mindfulness-y-neurobiologia.html
teele, H., Steele, M., & Fonagy, P. (1996). Associations amongattachment classifications of mothers, fathers, and their infants.Child Development, 67(2), 541---555.


































http://revistadepsicoterapia.com/eficacia-de-la- terapia-cognitiva-basada-en-la-atencion-plena-en-el-tratamiento-de-la-depresion.html




http://revistadepsicoterapia.com/mindfulness-en-la-terapia-dialectico-comportamental.html

http://revistadepsicoterapia.com/mindfulness-en-la-terapia-dialectico-comportamental.html



























































































































http://revistadepsicoterapia.com/la-atencion-plena- mindfulness-como-intervencion-clinica-para-aliviar-el-sufrimiento-y-mejorar-la-convivencia.html



















http://revistadepsicoterapia.com/conciencia- plena-mindfulness-y-psicoterapia-concepto-evaluacion-y-aplicaciones-clinicas.html



















http://revistadepsicoterapia.com/la-practica-de-la-meditacion-y-la-atencion-plena-tecnicas-milenarias-para-padres-del-siglo-xxi.html



http://revistadepsicoterapia.com/mindfulness-y-neurobiologia.html

http://revistadepsicoterapia.com/mindfulness-y-neurobiologia.html























SPECIAL ARTICLE

Corporate use of mindfulness and authentic spiritualtransmission: Competing or compatible ideals?

William Van Gordona,b,∗, Edo Shonina,b, Tim Lomasc, Mark D. Griffithsb

a Awake to Wisdom Centre for Meditation and Mindfulness Research, Nottingham, UKb Psychology Department, Nottingham Trent University, UKc School of Psychology, University of East London, UK

Received 10 June 2016; accepted 25 June 2016Available online 3 November 2016

KEYWORDSMindfulness;Work-relatedwellbeing;Ethics;Authentic spiritualtransmission;Job performance

Abstract There is consensus amongst both the scientific and Buddhist community that mindful-ness --- when correctly taught and practised --- leads to a range of beneficial outcomes. However,there has been little evaluation of what happens when mindfulness is incorrectly taught, or ispractised with a selfish rather than selfless intention. Nowhere is the importance of this issuemore pertinent than the recent and growing assimilation of mindfulness for employees by largecorporations. The current paper introduces the principle of ‘authentic spiritual transmission’and examines how it can inform the integration of mindfulness into the corporate workplace.Three questions are explored: (i) what spiritual infrastructure is required to operationalizemindfulness that is effective in the corporate setting? (ii) to what extent can ‘inner change’induced by mindfulness substitute the need for corporations to foster healthy ‘external’ work-ing conditions? and (iii) is mindfulness corruptible or does it have a natural defence mechanism?The paper addresses these questions by synthesizing relevant Buddhist discourses, evaluatingrecent theoretical and empirical findings concerning the use of mindfulness in corporate sett-ings, and examining how second-generation mindfulness-based interventions can inform thistopical area of scholarly debate.© 2016 Mindfulness & Compassion. Published by Elsevier Espana, S.L.U. All rights reserved.

PALABRAS CLAVE Uso corporativo de la conciencia plena y la transmisión espiritual auténtica: ¿ideales
Conciencia plena;Bienestar laboral;
contrapuestos o compatibles?

ntre los científicos y la comunidad budista sobre el hecho de quedo se ensena y se practica correctamente---- provoca una variedad

Sin embargo, ha habido poca evaluación de lo que ocurre cuando

Ética;Transmisión espiritualauténtica;

Resumen Hay consenso ela conciencia plena ----cuande resultados beneficiosos.

Rendimiento laboral la conciencia plena no se ensena correctamente o se practica con una intención más egoísta

∗ Corresponding author.E-mail address: [email protected] (W. Van Gordon).

http://dx.doi.org/10.1016/j.mincom.2016.10.0052445-4079/© 2016 Mindfulness & Compassion. Published by Elsevier Espana, S.L.U. All rights reserved.






76 W. Van Gordon et al.

que altruista. En ninguna parte la importancia de esta cuestión es más pertinente que en laasimilación reciente y creciente de la conciencia plena por parte de los empleados de grandesempresas. El presente artículo introduce el principio de «transmisión espiritual auténtica» yanaliza cómo puede explicar la integración de la conciencia plena en el lugar de trabajo en unaempresa. Se plantean 3 preguntas: a) ¿qué infraestructura espiritual es necesaria para llevara la práctica la conciencia plena que es eficaz en el entorno empresarial?; b) ¿en qué medidaun «cambio interno» provocado por la conciencia plena puede sustituir la necesidad de lasempresas de promover condiciones laborales «externas» saludables? y c) ¿es posible corromperla conciencia plena o esta tiene un mecanismo de defensa natural? El artículo aborda estaspreguntas mediante la síntesis de discursos budistas pertinentes, la evaluación de los últimoshallazgos teóricos y empíricos relativos a la utilización de la conciencia plena en los entornosempresariales y el análisis de cómo las intervenciones basadas en la conciencia plena de segundageneración pueden explicar este tema de debate académico.© 2016 Mindfulness & Compassion. Publicado por Elsevier Espana, S.L.U. Todos los derechosreservados.

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merican corporations spend an average of $13,000 permployee per year on direct and indirect healthcare costsKlatt, Wise, & Fish, 2015). Approximately 20% of Americanmployees take time off work due to a stress-related illnessn a given twelve-month period, and 63% would welcomeupport and advice from their employer on how to improveheir health and wellbeing (Crawford, 2014). In countriesuch as the United Kingdom, work-related stress results in aoss of 10 million working days each year (Health and Safetyxecutive, 2015). Moreover, since 2009, the number of sickays lost to stress, depression, and anxiety in the Unitedingdom has increased by 24%, while the number lost to seri-us mental illness has doubled (Davies, 2014). Consequently,t is unsurprising that there is growing interest amongstarge corporations into techniques such as mindfulnesshat are reported to directly improve employee wellbeing,nd indirectly improve productivity and profitability (Dane,010).

Corporations such as General Mills, Target, Apple,oogle, Carlsberg, Sony Corporation, Ikea, Nike, Procter

Gamble, AOL, Goldman Sachs, Transport for London,nd Monsanto are reported to have implemented employeeindfulness programs, and according to one media report,

ver 25% of American companies have done likewiseHuffington, 2013). However, given that amongst traditionalontemplative communities mindfulness is employed as aeans of fostering spiritual growth (Purser, 2015), con-

erns have arisen regarding the use of mindfulness in theorporate setting. More specifically, some researchers, Bud-hist teachers, and business leaders have asserted thatntroducing mindfulness into the corporate workplace coulde harmful to (i) the Buddhist teachings (i.e., due to themeing misappropriated and misapplied), (ii) society (i.e.,ue to employees using mindfulness to advance their careernd/or wealth in ways that are ethically unwholesome), andiii) employees (i.e., due to greater demands being placed
pon them by corporations adopting the Buddhist rhetorichat stress is a ‘mind-made’ phenomenon that can be trans-uted by practicing mindfulness) (Macaro & Baggini, 2015;urser & Ng, 2015; Purser, 2015).
At the core of Buddhist thought is the notion that stress-- and indeed all forms of suffering --- are ‘mind-made’ con-tructs that can be overcome by eliminating erroneous viewsoncerning the ultimate manner in which the ‘self’ and real-ty exist (Dalai Lama, 1995; Van Gordon, Shonin, & Griffiths,016a). Although there are differing Buddhist perspectives,ltimately, all traditional schools of Buddhist practice sub-cribe to the view that by dedicating one’s life to spiritualractice, it is possible to start cultivating a mind that isnconditionally happy (i.e., irrespective of external con-itions) (Chah, 2011; Dalai Lama, 1995; Huang Po, 1982;hat Hanh, 1999). The term ‘dedicating one’s life’ is keyere because although Buddhism asserts that it is possibleo permanently transmute suffering, it likewise asserts thathis can only happen pursuant to the spiritual practitionerompletely abandoning themselves to the Buddhadharmain the sense used here, the Sanskrit term Buddhad-arma means ‘the truth’ or ‘true teachings’) (Khyentse,006).

Some corporate mindfulness stakeholders appearo maintain that there are minimal risks associatedith introducing mindfulness into the corporate setting

Huffington, 2013). The Trojan Horse metaphor is oftenmployed in this respect in order to highlight the view thatindfulness will ‘work from within’ and gradually cause

orporations to become more socially responsible and lessrofit-focused. There are also reports that some corporateindfulness advocates have gone one step further byrawing direct comparisons between their work and theistorical Buddha providing teachings to kings and wealthyerchants (Purser, 2015). However, as noted by Purser,

uch claims appear to be made with limited considerationf the context in which the Buddha offered his teachings tonterested parties:

While the Buddha taught the dharma to leaders and themerchant class, what he taught was not a mindfulness-based intervention so they could simply feel better about
themselves, nor did he simply provide them a meditativetechnique for improving their concentration so that theycould obtain even more wealth and riches, rather, theBuddha advocated a wiser form of ethical leadership that

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Mindfulness and spiritual transmission

counteracted the mental poisons of greed, ill will anddelusion (2015, p. 37).

Thus, when aspects of Buddhist practice are taken outof context and applied in settings that are primarily con-cerned with monetary --- as opposed to spiritual --- gain,claims that mindfulness can eliminate stress or induce an‘enlightened workplace’ become contentious. Given theseissues and concerns, the present paper introduces the prin-ciple of ‘authentic spiritual transmission’ and examines howit can inform the integration of mindfulness for employeesinto large corporations. More specifically, three questionsare explored: (i) what spiritual infrastructure is requiredto operationalize mindfulness that is effective in the cor-porate setting? (ii) to what extent can ‘inner change’induced by mindfulness substitute the need for corpora-tions to foster healthy ‘external’ working conditions? and(iii) is mindfulness corruptible or does it have a naturaldefence mechanism? The present paper addresses thesequestions by synthesizing relevant Buddhist discourses, eval-uating recent theoretical and empirical findings concerningthe use of mindfulness in corporate settings, and examin-ing how second-generation mindfulness-based interventions(SG-MBIs) can inform this topical area of scholarly debate.

Authentic spiritual transmission

There are numerous perspectives on what is implied by theterm ‘spiritual’, but for the purposes of this paper, ‘spiritual’is understood to constitute ‘that which helps to transcendselfhood’. This delineation of spiritual is consistent with theBuddhist position that selfishness and craving for a ‘me’,‘mine’, or ‘I’ is the cause of suffering, and that removingbelief in selfhood is the cause of liberation (Van Gordon,Shonin, & Griffiths, 2016b; Van Gordon, Shonin, Griffiths, &Singh, 2015a).

According to Shonin and Van Gordon (2015a), an authen-tic spiritual practitioner or teacher is an individual that hastranscended the ego and cultivated a high level of spiritualawakening. Such an individual could be firmly on the path toenlightenment, or a fully enlightened Buddha (Shonin & VanGordon, 2015a). An authentic spiritual teacher emanatesspiritual awareness and is not necessarily a Buddhist scholar(Nhat Hanh, 1999). Authentic spiritual transmission (AST)takes place when an authentic spiritual teacher (known asthe ‘right teacher’) imparts spiritual insight and awaken-ing onto a suitably disposed student (known as the ‘rightstudent’) (Shonin & Van Gordon, 2015a). There are variousperspectives within Buddhism on what makes a student asuitable vessel for AST, but in general the student shouldbe (i) willing to devote their life to spiritual practice, (ii)innately possessing spiritual acumen (possibly accumulatedover successive lifetimes of spiritual practice), (iii) perse-vering and courageous, (iv) dissatisfied with cyclic existence(cyclic existence refers to the Buddhist notion that until theyliberate themselves, sentient beings continue to migratethrough a cycle of birth, life, death, and rebirth; Dalai Lama,1995), and (v) eager to foster qualities of humility, faith,
compassion, patience, joy, and generosity (Tsong-Kha-pa,2004).
In the Canki sutta, the Buddha advises that the principalmark of an authentic spiritual teacher is that their behavior

tati

77

s not influenced by greed, hatred, or delusion (Nanamoli &odhi, 2009). As suggested by the following words recorded

n the Sandaka sutta (and attributed to the Buddha’s disci-le Ananda), the Buddha placed limited emphasis on otheractors, including whether the teacher is a recipient of araditional spiritual teaching lineage:

Again, Sandaka, here some teacher is a traditionalist,one who regards oral tradition as truth, he teaches aDharma by oral tradition, by legends handed down, bythe authority of the collections. But when a teacher isa traditionalist, one who regards oral tradition as truth,some is well transmitted and some badly transmitted,some is true and some is otherwise (Nanamoli & Bodhi,2009, p. 624).

Consistent with these accounts of the Buddha’s teach-ngs, Shonin and Van Gordon (2015a) argue that there are noworldly qualifications’ that an individual can attain in ordero be conferred the status of an authentic spiritual teacher:

If a person has genuine spiritual realization, they areauthorized to transmit the spiritual teachings. All titles,held-lineages, endorsements, acclamations, life accom-plishments, life mistakes, and years spent in trainingare irrelevant. . .If a person is without genuine spiri-tual realization, they have no such authority. All titles,held-lineages, endorsements, acclamations, life accom-plishments, life mistakes, and years spent in trainingare irrelevant. . .Ultimately, true authorization to trans-mit the spiritual teachings comes from awakening to thetimeless truth of emptiness. It seems that some form ofspiritual guide is required to effectuate this awakening(p. 143).

The primary methods by which AST can be acquired,eveloped, and maintained are via: (i) oral instructionTsong-Kha-pa, 2004), (ii) the written word (Gampopa,998), (iii) mind-to-mind transmission from a teacherresent in physical form (Nyoshul & Surya Das, 1995), andiv) mind-to-mind transmission from a teacher not presentn physical form (Urgyen, 2000). It should be understoodhat the ultimate purpose of AST (i.e., that occurs when theright teacher’ encounters the ‘right student’) is to bringhe student into contact with the ‘teacher within’ (Shonin

Van Gordon, 2015a). Accessing and awakening the teacherithin constitutes AST in its purest form and this notion haseen alluded to by Nyoshul and Surya Das (1995) as follows:

If you meet a teacher who represents the lineage andtradition of Dzogchen, this is also a partial idea; it isgood fortune, but it is still a limited notion. . .Authenticsacred vision, the pure perception often mentioned inthe tantric path, implies that we can and should seeeverything as perfectly pure and inherently good; thatis, beyond good and bad, perfectly complete just as it is(p. 115).

The most essential point appears to be that without thentervention of a spiritually realized teacher, and without
he student being a receptive vessel, AST does not occurnd the student remains unable to fully access or awakenhe inner teacher (Urgyen, 1995). This principle (i.e., themportance of a spiritually realized teacher) applies to the

7

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eaching and learning of all aspects of Buddhist practice,ncluding mindfulness.

hat spiritual infrastructure is requiredo operationalize mindfulness that is effectiven the corporate setting?

arious change management strategies have been imple-ented to maximize the chances of mindfulness being

uccessfully integrated into the employee’s workplace (Klattt al., 2015). Such approaches typically seek to secureanagement and employee buy-in, deliver tailored inter-

entions, and capture data (i.e., to feedback to senioranagement) on how such interventions improve various

spects of work-related wellbeing and/or work effective-ess (Klatt et al., 2015). For example, the multinationalood company General Mills is reported to have deliv-red mindfulness training to over 400 employees, wherever 80% reported taking time each day to optimizeheir personal productivity following mindfulness train-ng compared to 23% pre-intervention (Gelles, 2012).he same company found that 80% of senior execu-ives that participated in mindfulness training reportedmprovements in decision-making competency (Gelles,012).

These internal findings are consistent with reports inhe academic literature where mindfulness has been showno lead to significant improvements in employee mentalealth outcomes, including anxiety (Dobie, Tucker, Ferrari,

Rodgers, 2016), depression (Mealer et al., 2014), stressManocha, Black, Sarris, & Stough, 2011), burnout (Krasnert al., 2009), sleep quality (Frank, Reibel, Broderick,antrell, & Metz, 2015), and dispositional mindfulnessMalarkey, Jarjoura, & Klatt, 2013). Mindfulness has alsoeen shown to improve employee physical health outcomesuch as diet (Aikens et al., 2014), response to flu immuniza-ion (as measured via changes in antibody titers; Davidsont al., 2003), and salivary �-amylase levels (Duchemin,teinberg, Marks, Vanover, & Klatt, 2015). Furthermore,indfulness in the workplace has been linked to job per-

ormance in various ways, including (i) client-centeredmpathic care in health-care professionals (e.g., Krasnert al., 2009), (ii) positive organizational behavior (Aikenst al., 2014), (iii) organizational innovativeness and per-ormance (Ho, 2011), and (iv) work-related self-efficacyJennings, Frank, Snowberg, Coccia, & Greenberg, 2013;oulin, Mackenzie, Soloway, & Karayolas, 2008).

Although these findings are promising, the fact of theatter is that what is being implemented by corporations

and researchers) is not necessarily mindfulness. Accord-ng to all systems of Buddhist thought that recognizeindfulness as a key feature of meditative development,indfulness is deemed to be a spiritual practice (Shonin,

an Gordon, & Griffiths, 2014a). It is introduced as the sev-nth aspect of a fundamental teaching known as the Nobleightfold Path (Bodhi, 1994). Whilst the Noble Eightfoldath (obviously) consists of eight different elements, these
lements do not function as standalone entities. In otherords, it is not the case that an individual begins with therst aspect of the Noble Eightfold Path --- known as ‘rightiew’ --- and only moves onto the second (known as ‘right
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W. Van Gordon et al.

ntention’) after concluding their training in ‘right view’.ndeed, although the Noble Eightfold Path has eight differ-nt aspects, it is a single path and a single practice (Vanordon et al., 2015a). This means that in the absence of

right view’, ‘right intention’, ‘right speech’, ‘right action’,right livelihood’, ‘right effort’, and ‘right concentration’,here cannot be ‘right mindfulness’.

The present authors argue that contemporary mind-ulness (hereinafter referred to as ‘‘mindfulness’’),s it is operationalized in mindfulness-based interven-ions (MBIs) such as Mindfulness-Based Stress ReductionMBSR), Mindfulness-Based Cognitive Therapy (MBCT), andorporate-Based Mindfulness Training, does not always meethe traditional Buddhist criteria for authentic mindfulnessMcWilliams, 2011; Purser, 2015; Rosch, 2007; Shonin et al.,014a). The main reason for this is because contemporary‘mindfulness’’ is invariably taught in the absence of each ofhe seven aforementioned Noble Eightfold Path elements,nd it is generally not taught with the primary intention ofostering spiritual growth. A further reason why contem-orary ‘‘mindfulness’’ techniques cannot necessarily beonsidered authentic from the Buddhist perspective, is theact that most contemporary ‘‘mindfulness’’ instructorsave not met Shonin and Van Gordon’s (2015a) afore-entioned criteria of being a realized spiritual teacher.lthough the situation is gradually improving, the expe-ience of some instructors of ‘‘mindfulness’’ is limitedo attendance at just one eight-week course followedy one year of self-practice (Mental Health Foundation,010).

It would be inaccurate to assert that contemporaryindfulness-based interventions are ineffective, because

as indicated above) empirical data suggests otherwise.owever, to date, all that such data demonstrate is thatertain MBIs are effective for initiating change across pre-efined outcomes, and over relatively short periods ofime (e.g., 3---24 months). Although this change is ofteneported as substantial, robustly conducted meta-analysisemonstrate that the effectiveness of MBIs is equivalent tohat can be expected from using anti-depressants in a pri-ary care population (i.e., small to moderate effect sizes;oyal et al., 2014). In fact, with the exception of treat-

ng depression and anxiety in clinical populations, theres insufficient high quality evidence at present to supporthe wide-scale utilization of mindfulness for effecting last-ng psychological and/or behavioral change --- including inhe workplace setting (Shonin, Van Gordon, & Griffiths,015).

The present authors argue that most ‘‘mindfulness’’pproaches teach an ‘attention-based psychological tech-ique’ that has demonstrable real-world applications.owever, this technique should not be confused with authen-ic Buddhist mindfulness. For the reasons outlined above,indfulness only becomes authentic (i.e., in the Buddhist

ense) when it becomes spiritual, and it only becomespiritual when taught by an authentic spiritual teacher.herefore, in essence, if an organization wishes to suc-essfully introduce its employees to authentic mindfulness,he only indispensable infrastructure required is that of an
uthentic spiritual teacher. All other considerations (e.g.,ype of mindfulness intervention, programme length, pro-ected time for employees to practice mindfulness, space

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designation, amount of instructor---participant contact time,and range of meditation techniques employed) are of lesserimportance.

To what extent can ‘inner change’ inducedby mindfulness substitute the needfor organizations to foster healthy ‘external’working conditions?

Santideva, an 8th Century Indian Buddhist saint and philoso-pher, asserted that rather than cover the entire outdoorswith leather, it is more practical to adorn the feet with aleather sole (Santideva, 1997). As outlined above, centralto Buddhist thought is the notion that any form of sufferingcan be transformed by spiritual training, and that this ulti-mately liberates the mind (Dalai Lama, 1995). The presentauthors believe that the position of Santideva and other Bud-dhist adepts (including the Buddha) is robust, and that it ispossible to foster meditative awareness to such an extent,that egoistic clinging (and therefore suffering) is abandoned.Under such circumstances, there is no longer a reificationof ‘self’ through which suffering can manifest (Huang Po,1982). This is not to say that an enlightened being does notexperience (for example) pain when they trap their finger ina door, but they experience such pain ‘as it is’ (Urgyen, 2000)--- without attachment and without relating to it as some-thing that belongs to a ‘me’, ‘mine’, or ‘I’ (for a detailedexplanation of the Buddhist concepts of attachment, empti-ness, and non-self, see Shonin et al., 2014a).

Based on empirical findings, it appears that after only8---12 weeks of training, employees that participate in MBIscan increase resilience to psychological distress caused bysuboptimal working conditions (Klatt et al., 2015). However,the notion of mindfulness equipping employees with the nec-essary psychological and spiritual resources to transcend theself --- and thus become impervious to toxic work conditions--- is unrealistic. The primary reasons for this are that (i)as noted above, the ‘‘mindfulness’’ that is typically taughtby organizations is not necessarily authentic or sufficientlypotent according to the Buddhist conceptualization, and (ii)even where mindfulness is correctly taught and practiced,it generally takes many years (if not decades) of diligentday-to-day practice to attain high levels of spiritual insight(i.e., whereby mental quietude is profound, unconditional,and self-sustaining) (Shonin et al., 2014a).

In recent years, a new generation of MBI, that are(unsurprisingly) termed second-generation MBIs (SG-MBIs),have been formulated and empirically investigated. Com-pared to first-generation mindfulness-based interventions(FG-MBIs) such as MBSR and MBCT, SG-MBIs --- such as Medita-tion Awareness Training (MAT) --- integrate a greater rangeof meditation techniques and operationalize mindfulnessin a manner deemed to be more congruent with the tra-ditional Buddhist model (Van Gordon, Shonin, & Griffiths,2015). FG-MBIs generally subscribe to Kabat-Zinn’s (1994)definition that mindfulness involves ‘‘paying attention in a
particular way: on purpose, in the present moment, andnon-judgmentally’’ (1994, p. 4). Conversely, according tothe SG-MBI delineation, mindfulness is deemed to be ‘‘theprocess of engaging a full, direct, and active awareness of
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79

xperienced phenomena that is (i) spiritual in aspect, andii) maintained from one moment to the next’’ (Van Gordont al., 2015, p. 592).

The term ‘direct awareness’ in the SG-MBI formulationontradicts the use of the term ‘non-judgemental’ in theG-MBI definition. According to Van Gordon et al. (2015),ather than teaching participants to be ‘non-judgemental’,G-MBIs encourage them to be (amongst other things) (i)thically discriminative (i.e., responsible world citizens thatre aware of both the short-term and long-term conse-uences of their actions), and (ii) spiritually empowered toelate to mindfulness as a ‘way of life’, rather than a thera-eutic technique that is employed under certain conditionsut not others.

Studies of MAT (from randomized controlled trials andlinical case studies) have shown that 8---10 weeks of trainingan help effectuate statistically and/or clinically significantmprovements in employee levels of (i) job performanceas rated by employee’s line managers), (ii) work-relatedtress, (iii) job satisfaction, (iv) attitudes toward work, andv) workaholism (Shonin & Van Gordon, 2015b; Shonin, Vanordon, Dunn, Singh, & Griffiths, 2014; Shonin, Van Gordon,

Griffiths, 2014b; Van Gordon, Shonin, & Griffiths, 2016c).ualitative studies have likewise indicated that MAT can

mprove participant’s ability to transfer the locus of controlor stress from external conditions to internal metacog-itive and attentional resources (Shonin & Van Gordon,015b; Shonin, Van Gordon, & Griffiths, 2014c; Van Gordon,honin, & Griffiths, 2016d). Studies of other SG-MBIs ---uch as Mindfulness-Based Positive Behavior Support --- havehown that SG-MBIs can improve caregiver levels of stress,urnover, and work-related injury, as well as reduce their usef physical restraints (Singh, Lancioni, Karazsia, & Myers,016; Singh et al., 2009, 2015).

Findings from SG-MBI qualitative studies are often accom-anied by participants reporting increases in spiritualwareness that are arguably more profound than compar-tive qualitative studies of FG-MBIs (Van Gordon et al.,016d). Outcomes from SG-MBI research are promising and

-- at least from the Buddhist perceptive --- their greaterocus on authentic spiritual transmission could mean thathey equip participants with greater psycho-spiritual cop-ng resources relative to FG-MBIs. However, to date, noead-to-head studies have been conducted that allow reli-ble inferences to be drawn as to the relative effectivenessf FG-MBIs and SG-MBIs for different population groups.urthermore, the manner in which SG-MBIs are being inte-rated into research and applied settings appears to be moren-keeping with providing prospective mindfulness practi-ioners with a greater choice of MBI rather than seeking toompete with FG-MBIs.

Thus, notwithstanding the fact that SG-MBIs are intendedo be more spiritual in nature, as the situation currentlytands it appears (i.e., based on available empirical findings)hat mindfulness --- whether delivered according to the FG-BI or SG-MBI model --- can be used by corporations to make

mprovements to work-related wellbeing and/or work effec-iveness among employees. However, corporations should
e realistic about what outcomes can be induced by bothG-MBIs and SG-MBIs and should consider them as just onelement of the overall workplace infrastructure that canelp to optimize productive working conditions.

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Mindful working and mindful managing are arguably keyspects of a healthy work environment, but over-reliancen mindfulness could directly or indirectly exert pressuresn employees to endure work stresses that might otherwisee eliminated by (for example) making changes to humanesource management systems (e.g., flexible work schemes,nnovative appraisal and reward systems, etc.). The viewf the present authors is that in the majority of instances,orporations that have chosen to make mindfulness avail-ble to employees are well intended (i.e., they are seeking

win-win situation), and in so far as mindfulness train-ng has encouraged a rhetoric of ‘stress is in the mind’, ithould not be discounted that this may have occurred due tooor teaching and/or project implementation on the part ofhird-party mindfulness consultants (or a small number of so-alled mindfulness experts in cases where corporations havenstructed their own employees to deliver the training).

s mindfulness corruptible or does it have natural defence mechanism?

here an employee is taught mindfulness correctly, theyre also being directly or indirectly instructed in prac-ices intended to cultivate ethical awareness (i.e., ‘rightpeech’, ‘right action’, ‘right livelihood’), a compassionatend spiritual outlook (i.e., ‘right intention’, ‘right effort’),nd wisdom (i.e., ‘right view’) (Nhat Hanh, 1999). Conse-uently, correct and authentically taught mindfulness meanshat employees will also be learning how to become wisernd more responsible world citizens (Shonin & Van Gordon,014). Under such conditions, there is a ‘win’ for themployee, employer, Buddhism, and society more generally.

As noted earlier, where mindfulness is taught outside of aystem of ethical and spiritual values, it is not ‘true’ mind-ulness that is being taught, but rather an ‘attention-basedsychological technique’. Since what is being propagatedn such situations is not authentic mindfulness, there isrguably limited value in being concerned with the conse-uences of employees or corporations misappropriating theindfulness teachings. In other words, it is difficult to justify

aising a grievance that a corporation is misusing mindful-ess, if in fact what is being implemented is not mindfulnessShonin & Van Gordon, 2014).

Exposure to ‘‘mindfulness’’ could foster an interest inore profound forms of spirituality (Lomas, Cartwright,

dginton, & Ridge, 2014), but it could also quash spiri-ual inquisitiveness while it is still at an embryonic stageFarias & Wikholm, 2015). Indeed, it is the present authorsiew that a significant proportion of individuals enticed by‘mindfulness’’ to explore spiritual practice have the ‘wrongntention’ and are motivated, or partially motivated, byesire to (for example) accrue wealth, follow a fashion,iscover friends or relationship partners, or advance theirareer. However, despite this unfortunate scenario, Shoninnd Van Gordon (2014) have asserted that it is precisely thiswrong intention’ that triggers a natural defence mechanismf the spiritual teachings:

If a person comes into contact with the Dharma who isnot ready to receive the teachings, or who intends to usethem for selfish or negative purposes, their wrong inten-tion will prevent the teachings from taking root within

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their being. In fact, all that they will receive will bea theoretical and superficial account of the teachings ---and even this won’t be properly understood (p. 1).

Furthermore, as implied by the following words of theuddha (who refers to himself below as the Tathagata),here an individual has a ‘wrong intention’, it is generally

he case than an authentic spiritual teacher will refuse toeach them:

Some misguided men here formulate a question, cometo the Tathagata, and ask it. In that case, Sunakkhatta,though the Tathagata has thought: ‘I should teach themthe Dhamma,’ he changes his mind (Nanamoli & Bodhi,2009, pp. 861---862).

Specific Buddhist systems of thought divide history intohases that correspond to the ‘health’ of the spiritual teach-ngs during a given period of time (Van Gordon, Shonin,riffiths, & Singh, 2015b). For example, ‘the age of true

aw’ (Sanskrit: saddharma, Japanese: shobo) correspondso the period when the historical Buddha lived and taughtome 2500-years-ago, and when the spiritual teachings wereeemed to be flourishing (Endo, 1999). This was followedy the ‘age of semblance dharma’ (Sanskrit: pratirupad-arma, Japanese: zobo), a period where authentic spiritualeachings were deemed difficult to happen upon. The cur-ent period of time (i.e., approximately the last 500---1000ears) is known as the ‘age of degeneration of the dharma’Sanskrit: pashchimadharma, Japenese: mappo) and cor-esponds to a period of widespread demise in spiritualeachings.

However, although, according to the Buddhist view were currently in a period of spiritual degeneration, theresent authors would argue that ultimately, the Buddhad-arma --- and indeed any true spiritual teaching --- such asuthentic mindfulness --- is indestructible. Santideva (1997)sserted that authentic spiritual teachings are expressions ofn ultimate truth of reality. Although individuals may fostereluded views regarding how to attain this ultimate truthi.e., enlightenment), the ultimate truth itself does notegenerate. Likewise, because authentic spiritual teachingsre direct expressions of a pervasive and enduring ultimateruth of existence, they too remain incorruptible (Norbu &lemente, 1999).

Thus, whether due to authentic spiritual teachers refus-ng to teach it, or due to it not revealing itself to individualsith impure intention, ‘spiritual truth’ --- of which authenticindfulness is an aspect --- remains protected from corrup-

ion (Norbu & Clemente, 1999). The minds of human beingsay move through phases of being less receptive to authen-

ic mindfulness (and other spiritual) teachings, but thessence of mindfulness does not wax nor wane. Therefore,t is the present authors view that corporations can (inad-ertently) misguide employees by teaching ‘‘mindfulness’’,ut it is both employee and employer that are subjected to

corrupted version of the teachings rather than mindfulnesseing corrupted per se.

iscussion

he Buddhist teachings, that include teachings on mindful-ess, are asserted to be universal in their application (Dalai

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Lama, 2000). It is inconsistent with the ethos of Buddhism,and that of spiritual practice more generally, to make spir-itual teachings available to some people, but deny themto others (Shonin & Van Gordon, 2014). Therefore, thereare strong grounds for arguing that individuals working forlarge corporations should be permitted the opportunity tomake an informed decision as to whether a particular formof spiritual practice is right for them. This can only happenif they have the opportunity to try it first. Consequently,the present authors support the integration of authenticmindfulness into the corporate workplace.

However, there is clearly a need for greater awarenessamongst corporations as to what (i) constitutes authen-tic mindfulness practice, (ii) outcomes can be realisticallyexpected from training employees in mindfulness tech-niques (i.e., steady improvements in work-related wellbeingand/or work effectiveness rather than the sudden emer-gence of an ‘enlightened workplace’), (iii) methodologicalfactors limit the findings from mindfulness research (i.e., inorder to counteract some of the scientific and media hypethat organizations may have encountered regarding mind-fulness efficacy), and (iv) health and commercial risks canarise due to a lack of authenticity (i.e., spiritual aptitude)on the part of the mindfulness teacher.

This latter point is arguably of crucial importancebecause very few studies have specifically sought to assesswhether mindfulness can incur adverse effects, and wheresuch studies have been conducted their outcomes havegiven rise for concern. For example, one recent study thatappeared to employ what the present authors would deemto constitute ‘‘mindfulness’’ (i.e., rather than authenticmindfulness) demonstrated that a mindful breathing exer-cise led to increased false memory susceptibility (Wilson,Mickes, Stolarz-Fantino, Evrard, & Fantino, 2015). Therealso exist reports of mindfulness fostering ‘depersonaliza-tion’ (Booth, 2014) and negative self-perceptions (Lomas,Cartwright, Edginton, & Ridge, 2015).

Although there are also few (if any) studies investigatingwhether mindfulness practiced according to the traditionalBuddhist model can lead to negative consequences, the tra-ditional model of mindfulness has been ‘tried and tested’for over 2500 years. Consequently, and while acknowledgingthat minor modifications, such as language secularization,are likely to be necessary when using mindfulness in corpo-rate (and other applied) settings, any major deviation fromthe traditional approach should be undertaken with caution.

In terms of the current state of affairs, it is probablyaccurate to conclude that authentic spiritual transmis-sion and corporate mindfulness constitute competing ratherthan compatible ideals. Nevertheless, the present authorsbelieve that there is scope for introducing authentic (andsecular) mindfulness into the corporate workplace in a man-ner that serves the spiritual, health, and financial interestsof both employers and employees. However, the effectiveimplementation of such an initiative would require funda-mental changes in the way corporations view both spiritualand commercial advancement, as well as the close col-laboration of spiritual leaders --- that possess at least a
moderate degree of genuine meditative realization --- withspiritually receptive business leaders. In the meantime, cor-porations may wish to carefully investigate the ‘spiritualauthenticity’ of their chosen mindfulness provider (whether
E

81

n employee or external consultant) to ensure that they (i)re not permitting individuals that do not understand theelicate intricacies of AST to teach mindfulness to theirorkforce, and (ii) are not paying for an occupational inter-ention that, when the hype surrounding ‘‘mindfulness’’ventually subsides, will leave them spiritually and finan-ially short-changed.

uthorship

e confirm that each of the abovenamed authors is respon-ible for the contents of the article, and had authority overanuscript preparation as well as the decision to submit theanuscript for publication.

onflicts of interest

he authors have no competing interests to declare.

eferences

ikens, K. A., Astin, J., Pelletier, K. R., Levanovich, K., Baase, C.M., Park, Y. Y., et al. (2014). Mindfulness goes to work: Impact ofan online workplace intervention. Journal of Occupational andEnvironmental Medicine, 56, 721---731.

odhi, B. (1994). The noble eightfold path: Way to the end ofsuffering. Kandy, Sri Lanka: Buddhist Publication Society.

ooth, R. (2014). Mindfulness therapy comes at a high price forsome, say experts. The Guardian,. Retrieved from: http://www.theguardian.com/society/2014/aug/25/mental-health-meditation

hah, A. (2011). The collected teachings of Ajahn Chah. Northum-berland: Aruna Publications.

rawford, R. (2014). 20% take time off work due to stress. EmployeeBenefits,. Retrieved from: https://www.employeebenefits.co.uk/20-take-time-off-work-due-to-stress/

alai Lama. (1995). The path to enlightenment. New York: SnowLion.

alai Lama. (2000). Ancient wisdom, modern world: Ethics for thenew millennium. London: Abacus.

ane, E. (2010). Paying attention to mindfulness and its effects ontask performance in the workplace. Journal of Management, 37,997---1018.

avidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M.,Muller, D., Santorelli, S. F., et al. (2003). Alterations in brainand immune function produced by mindfulness meditation. Psy-chosomatic Medicine, 65, 564---570.

avies, S. (2014). Annual report of the chief medical officer 2013,public mental health priorities: Investing in the evidence. Lon-don: Department of Health.

obie, A., Tucker, A., Ferrari, M., & Rogers, J. M. (2016). Preliminaryevaluation of a brief mindfulness-based stress reduction inter-vention for mental health professionals. Australasian Psychiatry,24, 42---45.

uchemin, A. M., Steinberg, B., Marks, D., Vanover, K., & Klatt,M. (2015). A small randomized pilot study of workplacemindfulness-based intervention for surgical intensive care unitpersonnel: Effects on self-reported stress and salivary �-amylaselevels. Journal of Occupational and Environmental Medicine, 57,
393---399.
ndo, A. (1999). Nichiren Shonin’s view of humanity: The finaldharma age and the three thousand realms in one thought-moment. Japanese Journal of Religious Studies, 26, 239---240.













































http://www.theguardian.com/society/2014/aug/25/mental-health-meditation














https://www.employeebenefits.co.uk/20-take-time-off-work-due-to-stress/

https://www.employeebenefits.co.uk/20-take-time-off-work-due-to-stress/



























































































































































































8

F

F

G

G

G

H

H

H

H

J

K

K

K

K

L

L

M

M

M

M

M

M

N

N

N

N

P

P

P

R

S

S

S

S

S

S

S

S

S

S

2

arias, M., & Wikholm, C. (2015). The Buddha pill: Can meditationchange you? London: Watkins Publishing Limited.

rank, J. L., Reibel, D., Broderick, P., Cantrell, T., & Metz, S.(2015). The effectiveness of mindfulness-based stress reductionon educator stress and well-being: Results from a pilot study.Mindfulness, 6, 208---216.

ampopa. (1998). The jewel ornament of liberation: The wish-fulfilling gem of the noble teachings (A. K. Trinlay Chodron, Ed.,& K. Konchong Gyaltsen, Trans.). New York: Snow Lion Publica-tions.

elles, D. (2012). The mind business. FT Magazine. Retrievedfrom: http://www.ft.com/cms/s/2/d9cb7940-ebea-11e1-985a-00144feab49a.html

oyal, M., Singh, S., Sibinga, E. M., Gould, N. F., Rowland-Seymour, A., Sharma, R., et al. (2014). Meditation programsfor psychological stress and well-being: A systematic review andmeta-analysis. JAMA Internal Medicine, 174, 357---368.

ealth and Safety Executive. (2015). Stress and psychologicaldisorders.. Retrieved from: http://www.hse.gov.uk/statistics/causdis/stress/index.htm

o, L. (2011). Meditation, learning, organisational innovation andperformance. Industrial Management and Data Systems, 111,113---131.

uang, Po. (1982). The Zen teaching of Huang Po: On the transmis-sion of the mind (J. Blofeld, Trans.). New York: Grove Press.

uffington, A. (2013). Mindfulness, meditation, wellness and theirconnection to corporate America’s bottom line. Huffington PostBusiness,. Retrieved from: http://www.huffingtonpost.com/arianna-huffington/corporate-wellness b 2903222.html

ennings, P. A., Frank, J. L., Snowberg, K. E., Coccia, M. A., &Greenberg, M. T. (2013). Improving classroom learning envi-ronments by cultivating awareness and resilience in education(CARE): Results of a randomized controlled trial. School Psychol-ogy Quarterly, 28, 374---390.

abat-Zinn, J. (1994). Wherever you go, there you are: Mindfulnessmeditation in everyday life. New York: Hyperion.

hyentse, D. (2006). Zurchungpa’s Testament. New York: Snow LionPublications.

latt, M., Wise, E., & Fish, M. (2015). Mindfulness and work-place wellbeing. In E. Shonin, W. Van Gordon, & M. D. Griffiths(Eds.), Mindfulness and Buddhist-derived approaches in mentalhealth and addiction (pp. 313---336). Gewerbestrasse, Switzer-land: Springer.

rasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L.,Chapman, B., Mooney, C. J., et al. (2009). Association of aneducational program in mindful communication with burnout,empathy, and attitudes among primary care physicians. Journalof the American Medical Association, 302, 1284---1293.

omas, T., Cartwright, T., Edginton, T., & Ridge, D. (2014). A religionof wellbeing? The appeal of Buddhism to men in London, UK.Psychology of Religion and Spirituality, 6, 198---207.

omas, T., Cartwright, T., Edginton, T., & Ridge, D. (2015). Aqualitative analysis of experiential challenges associated withmeditation practice. Mindfulness, 6, 848---860.

acaro, A., & Baggini, J. (2015). Businesses on the mindful-ness bandwagon. FT Magazine,. Retrieved from: http://www.ft.com/cms/s/0/ee65c5e4-c82f-11e4-8fe2-00144feab7de.html

alarkey, W. B., Jarjoura, D., & Klatt, M. (2013). Workplace basedmindfulness practice and inflammation: A randomized trial.Brain, Behaviour and Immunity, 27, 145---154.

anocha, R., Black, D., Sarris, J., & Stough, C. (2011). A ran-domised controlled trial of meditation for work stress, anxietyand depressed mood in full-time workers. Evidence-BasedComplementary and Alternative Medicine, http://dx.doi.org/10.1155/2011/960583

cWilliams, S. A. (2011). Contemplating a contemporary construc-tivist Buddhist psychology. Journal of Constructivist Psychology,24, 268---276.


ealer, M., Conrad, D., Evans, J., Jooste, K., Solyntjes, J.,Rothbaum, B., et al. (2014). Feasibility and acceptability ofa resilience training program for intensive care unit nurses.American Journal of Critical Care, 23, e97---e105. http://dx.doi.org/10.4037/ajcc2014747

ental Health Foundation. (2010). Mindfulness report. London:Author.

anamoli, B., & Bodhi, B. (2009). Majjhima Nikaya: The middlelength discourses of the Buddha (4th ed.). Massachusetts: Wis-dom Publications.

hat Hanh, T. (1999). The heart of the Buddha’s teaching: Trans-forming suffering into peace, joy and liberation. New York:Broadway Books.

orbu, C., & Clemente, A. (1999). The supreme source. The fun-damental tantra of the Dzogchen Semde. New York: Snow LionPublications.

yoshul, K., & Surya Das. (1995). Natural great perfection:Dzogchen Teachings and Vajra Songs. New York: Snow Lion Pub-lications.

oulin, P. A., Mackenzie, C. S., Soloway, G., & Karayolas, E. (2008).Mindfulness training as an evidenced-based approach to reduc-ing stress and promoting well-being among human servicesprofessionals. International Journal of Health Promotion andEducation, 46, 72---80.

urser, R., & Ng, E. (2015). Corporate mindfulness is bullsh*t:Zen or no Zen, you’re working harder and being paid less.Salon,. Retrieved from: http://www.salon.com/2015/09/27/corporate mindfulness is bullsht zen or no zen youre workingharder and being paid less/

urser, R. E. (2015). Clearing the muddled path of traditional andcontemporary mindfulness: A response to Monteiro, Musten, andCompson. Mindfulness, 6, 23---45.

osch, E. (2007). More than mindfulness: When you have a tiger bythe tail, let it eat you. Psychological Inquiry, 18, 258---264.

antideva. (1997). A guide to the Bodhisattva way of life (V. A. Wal-lace, & A. B. Wallace, Trans.). New York: Snow Lion Publications.

honin, E., & Van Gordon, W. (2014). Should mindfulness betaught to the military? Retrieved from: http://edoshonin.com/2014/08/08/should-mindfulness-be-taught-to-the-military/

honin, E., & Van Gordon, W. (2015a). The lineage of mindfulness.Mindfulness, 6, 141---145.

honin, E., & Van Gordon, W. (2015b). Managers’ experiences ofMeditation Awareness Training. Mindfulness, 4, 899---909.

honin, E., Van Gordon, W., Dunn, T., Singh, N., & Griffiths, M. D.(2014). Meditation Awareness Training (MAT) for work-relatedwellbeing and job performance: A randomized controlled trial.International Journal of Mental Health and Addiction, 12,806---823.

honin, E., Van Gordon, W., & Griffiths, M. D. (2014a). Theemerging role of Buddhism in clinical psychology: Towards effec-tive integration. Psychology of Religion and Spirituality, 6,123---137.

honin, E., Van Gordon, W., & Griffiths, M. D. (2014b). The treat-ment of workaholism with Meditation Awareness Training: Acase study. Explore: The Journal of Science and Healing, 10,193---195.

honin, E., Van Gordon, W., & Griffiths, M. D. (2014c). MeditationAwareness Training (MAT) for improved psychological wellbeing:A qualitative examination of participant experiences. Journal ofReligion and Health, 53, 849---863.

honin, E., Van Gordon, W., & Griffiths, M. D. (2015). The treat-ment efficacy of mindfulness: Where are we now? British MedicalJournal, 351, h6919. http://dx.doi.org/10.1136/bmj.h6919

ingh, N. N., Lancioni, G. E., Karazsia, B. T., & Myers, R. E.(2016). Caregiver training in mindfulness-based positive behav-
ior supports (MBPBS): Effects on caregivers and adults withintellectual and developmental disabilities. Frontiers in Psychol-ogy, 7 http://dx.doi.org/10.3389/fpsyg.2016.00098








































































http://www.ft.com/cms/s/2/d9cb7940-ebea-11e1-985a-00144feab49a.html

http://www.ft.com/cms/s/2/d9cb7940-ebea-11e1-985a-00144feab49a.html
























http://www.hse.gov.uk/statistics/causdis/stress/index.htm

http://www.hse.gov.uk/statistics/causdis/stress/index.htm











































http://www.huffingtonpost.com/arianna-huffington/corporate-wellness_b_2903222.html

http://www.huffingtonpost.com/arianna-huffington/corporate-wellness_b_2903222.html















































































































































































http://www.ft.com/cms/s/0/ee65c5e4-c82f-11e4-8fe2-00144feab7de.html

http://www.ft.com/cms/s/0/ee65c5e4-c82f-11e4-8fe2-00144feab7de.html























dx.doi.org/10.1155/2011/960583

dx.doi.org/10.1155/2011/960583





















dx.doi.org/10.4037/ajcc2014747

dx.doi.org/10.4037/ajcc2014747

















































































































http://www.salon.com/2015/09/27/corporate_mindfulness_is_bullsht_zen_or_no_zen_youre_working_harder_and_being_paid_less/
















































































http://edoshonin.com/2014/08/08/should-mindfulness-be-taught-to-the-military/

http://edoshonin.com/2014/08/08/should-mindfulness-be-taught-to-the-military/





















































































































































dx.doi.org/10.1136/bmj.h6919

dx.doi.org/10.3389/fpsyg.2016.00098

V

V

V

V

V

Wilson, B. M., Mickes, L., Stolarz-Fantino, S., Evrard, M.,


Singh, N. N., Lancioni, G. E., Karazsia, B. T., Myers, R. E., Winton,A. S. W., Latham, L. L., et al. (2015). Effects of training staff inMBPBS on the use of physical restraints, staff stress and turnover,staff and peer injuries, and cost effectiveness in developmentaldisabilities. Mindfulness, 6, 926---937.

Singh, N. N., Lancioni, G. E., Winton, A. S. W., Singh, A. N., Adkins,A. D., & Singh, J. (2009). Mindful staff can reduce the use ofphysical restraints when providing care to individuals with intel-lectual disabilities. Journal of Applied Research in IntellectualDisabilities, 22, 194---202.

Tsong-Kha-pa. (2004). (J. W. Cutler, G. Newland, Eds., & The LamrimChenmo Translation Committee, Trans.). The great treatise onthe stages of the path to enlightenment (Vol. 1) New York: SnowLion Publications.

Urgyen, T. (2000). As it is (M. B. Schmidt, K. Moran, Eds., & E. PemaKunsang, Trans.). Hong Kong: Rangjung Yeshe Publications.

Van Gordon, W., Shonin, E., & Griffiths, M. (2015). Towards a second-generation of mindfulness-based interventions. Australia andNew Zealand Journal of Psychiatry, 49, 591---592.

Van Gordon, W., Shonin, E., & Griffiths, M. D. (2016a).Buddhist emptiness theory: Implications for psychology. Psychol-ogy of Religion and Spirituality, http://dx.doi.org/10.1037/rel0000079

83

an Gordon, W., Shonin, E., & Griffiths, M. D. (2016b). Ontologicaladdiction: Classification, etiology, and treatment. Mindfulness,7, 660---671.

an Gordon, W., Shonin, E., & Griffiths, M. D. (2016c).Meditation Awareness Training for the treatment of sex addic-tion: A case study. Journal of Behavioral Addiction, 5,363---372.

an Gordon, W., Shonin, E., & Griffiths, M. (2016d). MeditationAwareness. Training for individuals with fibromyalgia syndrome:An interpretative phenomenological analysis of participant’sexperiences. Mindfulness, 7, 409---419.

an Gordon, W., Shonin, E., Griffiths, M. D., & Singh, N. N. (2015a).Mindfulness and the four noble truths. In E. Shonin, W. Van Gor-don, & N. N. Singh (Eds.), Buddhist foundations of mindfulness(pp. 9---27). New York: Springer.

an Gordon, W., Shonin, E., Griffiths, M. D., & Singh, N. N. (2015b).There is only one mindfulness: Why science and Buddhism needto work together. Mindfulness, 6, 49---56.

& Fantino, E. (2015). Increased false-memory susceptibil-ity after mindfulness meditation. Psychological Science, 26,1567---1573.


























































































































































dx.doi.org/10.1037/rel0000079

dx.doi.org/10.1037/rel0000079



















































































































































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RTÍCULO ESPECIAL

nfluencia de la práctica de mindfulness en la aperturaara conocer y comprender a los consultantesn contextos psicoterapéuticos. Un estudio cualitativoesde la perspectiva del terapeuta

aría Fernanda Silva Soler ∗ y Claudio Araya-Véliz

scuela de Psicología, Universidad Adolfo Ibánez, Santiago, Chile

ecibido el 21 de mayo de 2016; aceptado el 10 de septiembre de 2016isponible en Internet el 23 de noviembre de 2016

PALABRAS CLAVEPsicoterapia;Presencia;Apertura;Mindfulness;Co-presencia;Método cualitativo

ResumenObjetivos: El propósito del presente estudio fue describir y sistematizar la percepción de los psi-coterapeutas sobre la influencia que tendría la práctica personal de meditación en su aperturapara relacionarse con los consultantes.Metodología: Se realizó un estudio de carácter exploratorio y descriptivo, de naturaleza cuali-tativa. Participaron 8 psicólogos clínicos y un psiquiatra con formación psicoterapéutica, todosde enfoques teóricos variados y con formación y práctica personal de mindfulness. Se realiza-ron entrevistas semiestructuradas, las cuales fueron transcritas y analizadas cualitativamentedesde la Teoría Fundada.Resultados: Los resultados sugieren que la práctica constante de meditación mindfulness per-mitiría alcanzar una comprensión más profunda de la experiencia, conformándose un modode ser-en-el-mundo con mayor presencia y apertura. Esto cambiaría el modo de percibir a losconsultantes en psicoterapia y su rol como terapeutas.Conclusiones: La práctica personal de mindfulness influiría en el modo en que los psicoterapeu-tas se relacionan con su experiencia, particularmente en construir en conjunto un encuentroentre 2 modos de ser-en-el-mundo diferentes (entendido como co-presencia) y no como una
relación entre experto-paciente en la psicoterapia.© 2016 Mindfulness & Compassion. Publicado por Elsevier Espana, S.L.U. Todos los derechosreservados.
∗ Autor para correspondencia.Correo electrónico: [email protected] (M.F. Silva Soler).

ttp://dx.doi.org/10.1016/j.mincom.2016.10.003445-4079/© 2016 Mindfulness & Compassion. Publicado por Elsevier Espana, S.L.U. Todos los derechos reservados.






Mindfulness en contextos psicoterapéuticos 85

KEYWORDSPsychotherapy;Presence;Openness;Mindfulness;Co-presence;Qualitative methods

The influence of mindfulness in the openness to understand and learnabout the consultants in psychotherapeutic contexts. A qualitative studyfrom the therapist’s perspective

AbstractObjectives: The goal was to understand and describe the perception of psychotherapists aboutthe influence that their mindfulness practice would have in their openness with consultants.Methodology: This is an exploratory and descriptive study, with a qualitative method. The sam-ple was collected by a total of eight clinical psychologists from different theoretical-orientationsand one psychiatrist with psychotherapeutic training, all of them had a formal mindfulness trai-ning. Data was first collected with semi-structured interviews and then transcribed and analyzedfrom the perspective of the Grounded Theory.Results: The results suggest that the constant practice of meditation would lead to a deeperunderstanding of experience, changing their common way of being-in-the-world by bringingattention back to the present moment with openness to experience. This would be deployedas part of their personality, changing the way they perceive consultants in psychotherapy andtheir own role as therapists.Conclusions: Finally, this study proposes an understanding of therapy where the therapistdoesn’t sees it in terms of expert-patient, but as part of an encounter between two differentways of being-in-the-world (co-presence).© 2016 Mindfulness & Compassion. Published by Elsevier Espana, S.L.U. All rights reserved.

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Introducción

Frente a la tradición psicoterapéutica moderna y la idea deque existiría una verdad respecto a los problemas de laspersonas, sus causas y la eventual forma de solucionarlos,vuelve la exploración de la mente y de la vida emocionalcomo algo objetivable (Gergen, 2001) privilegiando la opi-nión de un experto que sería capaz de determinar la prácticaterapéutica adecuada en función de lo observado y anali-zado. Y ¿cuál es el riesgo de esta perspectiva? Olvidarnosde quién es y cuál es su contexto, las características, susintereses y las preocupaciones de los consultantes.

Hacia fines del siglo xx comenzó un cambio epistemo-lógico importante, manifestándose culturalmente como uninterés por dejar de ver estas verdades tradicionales comoirrefutables, llevando a la psicología a moverse hacia unparadigma posmoderno, esperando ser más sensible a lorelacional. Comenzó con esto un paso hacia una psicolo-gía que enfatiza lo dialógico por sobre lo monológico. Enel campo de la psicoterapia esta perspectiva influyó enmodificar los roles tradicionales de terapeuta y consultante;en este nuevo marco entran a primar la conversación y eldiálogo, reconociendo la posibilidad de aceptar nuevas pers-pectivas y siendo más flexibles en el encuentro, generándoseasí un cambio en la manera en que se concibe a los consul-tantes y a los terapeutas (Espinoza y Gutiérrez, 2012).

Junto a esta sensibilidad a lo posmoderno, en los últi-mos 15 anos ha aparecido un mayor interés en occidentesobre la práctica de meditación mindfulness y los benefi-cios que esta práctica puede tener. Entendiendo mindfulness
como la capacidad de darse cuenta del momento presente,integrándolo desde la aceptación (Germer, Siegel y Fulton,2005), se han demostrado sus efectos sobre la reduccióndel estrés y de la ansiedad (Brown y Ryan, 2003; Burgess,
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ropper y Wilson, 2005; Carlson, Silva, Langley y Johnson,013; Kabat-Zinn, 1990; Williams, Teasdale, Segal y Kabat-inn, 2011) y en una mayor conexión con ellos mismos, deus emociones y aportando en el desarrollo de hábitos másaludables (Garland, Gaylord y Park, 2009; Simón, 2007).in embargo, según lo investigado, parecen ser escasos losstudios respecto a la influencia que tendría esta prácticaarticularmente en los psicoterapeutas y en su manera deer y de relacionarse en la psicoterapia.

La presente investigación busca aportar desde la eviden-ia el diálogo que pueda establecerse entre la perspectivaosmoderna «construccionismo social» y la práctica deindfulness en el ámbito psicoterapéutico, particularmente

n indagar si la práctica de mindfulness favorece losrincipios que el construccionismo social promueve en psi-oterapia, entre los que están: la curiosidad por conocer altro, el diálogo, las conversaciones generativas y una mayorpertura hacia nuevas posibilidades y significados.

Específicamente, se pretende responder la siguienteregunta de investigación: «¿Cómo conciben los psicote-apeutas con formación en mindfulness que su prácticanfluiría en la apertura con que buscan conocer y compren-er a sus consultantes?».

ntecedentes teóricos y empíricos

a sensibilidad hacia lo relacional y el diálogon psicoterapia

omo parte del llamado paraguas de las terapias posmo-ernas (Anderson, 2007), la relación psicoterapéutica buscaer vista dando importancia al modo con que los tera-eutas se orientan de cara a la psicoterapia. Desde el

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onstruccionismo social, esto se manifiesta en su interés porromover en los terapeutas no solo un modo de ser, sinona filosofía de vida que dé importancia al encuentro entreas personas, a las posibilidades de dialogar desde una acti-ud que honre la presencia de ambos. Esta postura filosóficaAnderson, 2007) implica una búsqueda de congruencia conespecto al modo con que las personas se encuentran y seelacionan con otras.

Este enfoque postula que para situarse con curiosidad esecesario moverse desde el no-saber, que no significa olvi-ar los conocimientos del terapeuta, pero sí desarrollar unairada escéptica y tentativa con el fin de permitir al consul-

ante mostrarnos su experticia respecto a su vida (Anderson,007). Gadamer (1960, citado en Safran y Muran, 2000) men-iona que la percepción de la realidad está siempre limitadaor prejuicios y preconcepciones, por lo que es importanteituarse con una mente de principiante (Suzuki, 1970), parasí ser capaz de reconocer las interpretaciones que damos

los hechos y disponer de una mayor flexibilidad en con-extos psicoterapéuticos. Con esto, se entiende que «en laente del principiante hay muchas posibilidades, mientrasue en la del experto, muy pocas» (Suzuki, 1970, p. 21),ando como resultado un proceso de continua construccióne significados y de búsqueda de posibilidades, generando aartir del diálogo una mayor receptividad con respecto a lasxperiencias de la persona.

Esta postura plantea que el terapeuta no juega un role experto en psicoterapia, sino que cumple un rol media-or donde el diálogo, la interacción y el ámbito relacionalomienzan a jugar un rol central.

ntecedentes de la presencia relacionaln psicoterapia

or un lado, desde el Psicoanálisis relacional se presta aten-ión al aquí y ahora del encuentro entre consultante yerapeuta, siendo parte fundamental del trabajo terapéu-ico (Safran y Muran, 2000), reconociendo al diálogo comoarte importante del proceso clínico que es trabajado pres-ando atención a la alianza y al tipo de vínculo que se genera.or otro lado, esto se vincula con el construccionismo social

la concepción de la relación como creadora de conocimien-os y significados (Anderson, 1999; Gergen, 1996), siendoas ideas producto de las relaciones humanas y los signifi-ados, generados a partir del diálogo, del intercambio y lanteracción que es construida socialmente.

Ambas posturas dan importancia a la dimensión relacio-al y el modo con que el terapeuta se sitúa en psicoterapia,romoviendo un modo de situarse en el momento que esensible a lo que va ocurriendo momento a momento ena relación, siendo esta la razón por la que ambas fuerononsideradas en esta investigación desde una mirada pos-oderna.

a construcción de significados

uesto que al relacionarnos emergen particularidades que
aracterizan desde la interacción entre los participantesasta la comprensión e interpretación que hacemos deste proceso, desde el posmodernismo la visión del cons-ruccionismo social concibe a la relación como creadora
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e conocimientos y significados (Anderson, 1999; Gergen,996), y desde este paradigma se plantea que al ser lasdeas producto de las relaciones humanas, los significadosue atribuimos a los acontecimientos surgirían del diá-ogo, del intercambio y de la interacción que es construidaocialmente. Por esto, desde esta perspectiva, la mentes considerada como relacional y el desarrollo de sentidoería discursivo, por lo que los significados nunca seríannicos o fijos, sino que estarían continuamente en construc-ión (Anderson, 1999), diferenciándose de la perspectivaoderna, en donde el conocimiento, o la «verdad», es pira-idal y construida estableciéndose una jerarquía, de la cual

l terapeuta es un representante y un experto que actuarán base a teorías, prejuicios e ideas, fundamentando queu observación revelaría la historia del consultante «talomo es», dando cuenta también de cómo «debería» serAnderson, 1999).

El enfoque de la psicoterapia posmoderna, en cambio,ropone estar atento a la interacción y la co-construccióne significados que de esta surge, posicionando al lenguajeomo un medio para otorgar sentido y dar voz a los diferen-es relatos respecto a las situaciones de vida de las personas,romoviendo una actitud de respeto y búsqueda de colabo-ación con el otro, e intentando rescatar lo que funciona enada persona, reconociendo la agencia personal (Anderson,999; Tarragona, 2006). Busca ver a la terapia en términose una conversación ante la cual el terapeuta debe ser capaze posicionarse para abrir espacios de diálogo y estar en unstado de ser informado por el cliente (Stagoll, 1993) paraue desde el «no saber» y con un genuino interés, la realidadel paciente se manifieste en una comunicación dialógicaue permita la emergencia de nuevos temas, narrativas eistorias. Entonces, la meta de la conversación sería la crea-ión de oportunidades para el cambio cuando se da paso auevas maneras de significar y relacionarse con la experien-ia (Anderson y Goolishian, 1988).

Desde la postura filosófica del no saber y la mente derincipiante, el terapeuta tiene que hacer un esfuerzo cons-iente y un ejercicio constante de no basarse en categoríaseterministas que olvidan a la persona, a su quién, reco-ociendo sus particularidades y sus posibilidades de ser.mplica entonces el situarse con una actitud de aperturaara conocer, conversar y comprender a la persona y suificultad desde la propia perspectiva de esta y, según suxperticia, conversando desde la co-construcción para quemerja un nuevo sentido respecto a su forma de relacionarseon el problema.

indfulness y construccionismo socialn la persona del terapeuta

esde la perspectiva construccionista social, el diálogouega un rol central como generador de significado, y dentroe la tradición budista, es en el diálogo con la sabiduría queos practicantes alcanzan un mayor despertar: aquí, signi-cado y despertar van de la mano, siendo en este espíritue aprendizaje y reconocimiento donde se da la posibilidad
e una conexión y diálogo entre construccionismo social yindfulness (Gergen y Hosking, 2006).Los puntos de encuentro entre ambas posturas abren
spacios de indagación que la investigación en psicología

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Mindfulness en contextos psicoterapéuticos

clínica contribuiría a explorar con más detalle, puesto queen este punto de encuentro puede darse una creaciónconstante y consciente de nuevos significados al prestaratención, desde el no saber y con aperturidad a la situación,al contexto y a las relaciones. Tanto desde la concepciónde la práctica de meditación mindfulness, como desde elconstruccionismo social, existe un interés por indagar enprofundidad en un «estado que esté ligado a una formade percibir el mundo, y de cómo las personas lo estánhabitando» (Araya, 2010, p. 111). Así, la comprensión deun sí mismo relacional, por un lado, y el desarrollo de unapráctica de presencia plena o mindfulness, por otro lado, dalugar a una nueva perspectiva integradora, coherente con ladimensión inherentemente vincular de la psicoterapia, unaperspectiva de mindfulness relacional (Araya y Arístegui,2015).

Considerando estos antecedentes, se pensó investigarsobre la influencia de la práctica de mindfulness en psicote-rapeutas de diferentes orientaciones teóricas y que tuvieranen común una formación formal en mindfulness, junto conuna práctica personal en la misma línea, indagando sobrela influencia de esta práctica en su visión de la prácticaclínica.

Metodología

Diseno general

El presente estudio se desarrolló desde una metodologíacualitativa, dada la intención de indagar en las propias des-cripciones y reflexiones de los psicoterapeutas. Con este fin,según lo planteado por Krause (1995), se buscó profundi-zar en el modo en que un fenómeno del comportamientohumano se presenta, queriendo comprenderlo en base ala propia subjetividad y realidad dinámica que mantiene,desarrollándose un estudio descriptivo-exploratorio.

Participantes

Por medio de un muestreo no probabilístico de carác-ter intencional se seleccionaron a 8 psicólogos clínicosy un psiquiatra con formación psicoterapéutica, quienesparticiparon como colaboradores de este estudio. Fueronseleccionados en base a criterios de inclusión y de exclu-sión que contribuyeron a cumplir los objetivos del estudio.Los criterios de inclusión fueron: 1) psicoterapeutas (psicó-logos y psiquiatras con formación clínica y experiencia demínimo), 2) con 2 anos atendiendo pacientes, 3) que tuvieranformación en un curso experiencial de mindfulness, o diplo-mado, de al menos 8 semanas, y 4) que realicen una prácticapersonal de meditación constante de al menos 3 veces porsemana.

Respecto al modo de establecer contacto con los tera-peutas, se consideraron a ex-participantes de un diplomadode mindfulness, así como psicólogos con experiencia clí-nica que se dedican a realizar talleres o formación en eltema, utilizando posteriormente el método de «bola de
nieve», llegando finalmente a considerar a 9 psicoterapeu-tas, que se identificaron con diferentes corrientes teóricas:perspectiva humanista-existencial, psicoanalítica relacio-nal, Gestalt, construccionismo social y psicología budista.
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onsideraciones éticas

as entrevistas fueron realizadas en lugares previstos poros participantes, a quienes se les solicitó firmar una cartae consentimiento informado, donde expresaron su consen-imiento voluntario a participar en el estudio; además, seesguardó la confidencialidad de las identidades e infor-ación personal entregada, resguardo del acceso de la

nformación y mecanismos de devolución de la información.

ecolección de datos

e realizaron entrevistas semiestructuradas, desarrolladason la intención de conocer la experiencia y los significadostribuidos por los psicoterapeutas con respecto al tema enuestión. Estas entrevistas fueron transcritas literalmente yosteriormente codificadas.

nálisis de datos

uego de la transcripción de las primeras entrevistas, seio inicio a la etapa de codificación abierta, manteniendona estrategia de comparación permanente que permitióxtraer las principales categorías que fueron desarrolladasegún los datos recopilados, para luego realizar un análisisescriptivo de la información obtenida inicialmente (Krause,995). El establecimiento de relaciones entre las categoríase basó en la propuesta de la escuela metodológica de laeoría Fundamentada (Glaser y Strauss, 1967), siguiendo lastapas de descripción, ordenamiento conceptual y esquemaeórico, con el fin de avanzar hacia la construcción de unaeoría a partir de las interpretaciones de las propias personasediante el análisis sistemático de los datos.Se realizó un proceso de codificación a partir de 3 eta-

as: abierta, axial y selectiva, comenzando por un análisisescriptivo y luego de carácter relacional (Glaser y Strauss,967), dando cuenta del fenómeno que en mayor medidaue identificado a partir de las entrevistas.

esultados

continuación se presentan los resultados a nivel descrip-ivo y relacional.

nálisis descriptivo

n el análisis descriptivo surgieron 8 categorías principales:) motivación para practicar meditación; 2) aprendizajes deindfulness para su vida; 3) características de mindful-

ess; 4) significado de presencia; 5) significado de apertura;) características de los terapeutas que practican medita-ión; 7) modo de entender la terapia de los psicoterapeutasue practican meditación, y 8) características de la terapiauando el terapeuta practica meditación. A continuación seescribe brevemente cada una de ellas.

Con respecto la motivación por practicar meditación, lossicoterapeutas refieren que principalmente se debe a unnterés por conocerse a ellos mismos de una manera másrofunda.

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Sobre los aprendizajes que han obtenido de la prácticae mindfulness para sus vidas, se muestra un acuerdo allantear que el estar más presentes se manifestaría comon modo de ser-en-el-mundo, es decir, comprenden que serata de una posibilidad permanente y de una capacidadnnata de los seres humanos, generando un cambio en suodo habitual de ser en el día a día, de manera transversal.

sto se vincula con el segundo gran aprendizaje, que es laosibilidad de alcanzar una comprensión más profunda: dea experiencia, de las emociones (especialmente del sufri-iento, planteando que es inevitable), de las personas y de

a mente, lo que estaría relacionado con una capacidad parabservar con mayor profundidad, descubriendo y relacio-ándose con la experiencia de una manera diferente. Aquí,a sorpresa y la capacidad de acoger los sucesos juegan unapel importante, favoreciendo la capacidad de estar atentoin la necesidad de guiarse por preconcepciones o de emi-ir juicios automáticamente. Con estas subcategorías, losarticipantes reconocen por un lado a la práctica misma deeditación y, por el otro, al sustrato que existe tras esta yue se presenta como un aprendizaje para la vida.

La tercera categoría obtenida desde el relato de los psi-oterapeutas se refiere a las características de la prácticae meditación mindfulness. Los colaboradores de este estu-io plantean que se trata de una técnica, que es tambiénna práctica y que surge de un paradigma no-positivista, enonde mindfulness se considera como un concepto relativa-ente nuevo que integra principios budistas con respecto

la comprensión del ser humano, su mente y emociones.obre mindfulness, plantean que es más guiada y didácticaue otras prácticas y que sería como una «punta de iceberg»ue poco a poco puede ir conectando con una serie de prácti-as meditativas más profundas para las cuales serviría comouente de entrada.

Con respecto a la cuarta y quinta categorías, sobre elignificado de «presencia» y «apertura», serán abordados enayor detalle en la codificación axial de los datos, un pocoás adelante.La sexta categoría, sobre las características que tendrían

os terapeutas que practican meditación, se preguntó a losarticipantes de qué manera se sitúan al momento de hacererapia, así como el rol que consideran que tienen tanto losonsultantes como ellos mismos y la manera en que entien-en el proceso psicoterapéutico. Con esto, se identificaronna serie de cualidades que estos terapeutas tendrían alomento de estar en terapia con un consultante: 1) intentan

companar con presencia los distintos procesos de los con-ultantes, independiente de qué se trata; 2) comprendenue la terapia es un proceso en donde la comprensión, losignificados, son co-construidos en la relación; 3) planteanue saben esperar y que hacen el esfuerzo de escucharl otro atentamente; 4) exploran la experiencia de ser deas personas; 5) consideran que son capaces de flexibili-ar su propia mente, dándose cuenta de sus pensamientos,deas, prejuicios o diagnósticos automáticos; 6) son auto-onscientes de sí mismos, gracias a una mayor conciencia

auto-observación que se ve favorecida con la práctica deeditación, por lo que prestan mayor atención a su cuerpo,

sus emociones y a la influencia de sus pensamientos, y
) tienen una posición al hacer terapia caracterizada por laapacidad de centrarse y estar en apertura para estar conl otro.
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M.F. Silva Soler, C. Araya-Véliz

La séptima categoría se refiere al modo en que estos tera-eutas entienden la terapia. Sobre esto, plantean que lanfluencia de estar con presencia y en apertura se vinculaor un lado con una psicología que integra una práctica yn modo de ser, y por el otro, con una terapia más des-ierta que abre nuevas posibilidades. El primero de estose refiere a integrar en el ejercicio clínico la comprensiónrofunda y el modo de vivir que trae consigo la prácticae meditación, siendo un esfuerzo de coherencia por com-render la experiencia humana, las emociones, el modo enue funciona la mente, las cualidades y potencialidades deler humano, desde un enfoque que busca la conexión cona experiencia desde la aceptación, la apertura y la com-rensión del cambio como algo inevitable. El segundo puntoe refiere también al modo de ser de los terapeutas y elol que tienen en este proceso. Consideran que al integrarste modo de ser en terapia elimina la preocupación queueden tener los psicoterapeutas con respecto a un «ideal»e ser completamente certeros en sus interpretaciones oiagnósticos que vayan a realizar, ya que está dentro de lasosibilidades el equivocarse, por más rigurosos que quieraner en su trabajo. Plantean que desde este modo de ser laerapia se caracterizaría por dejar ver nuevas posibilidades,a que al tener un modo de conversar más apreciativo, seuelve más flexible y abre un espacio para el otro desdena presencia confirmadora que explora la experiencia sinnfocarse meramente en lo analítico, requiriendo del tera-euta la capacidad de saber esperar y de tomar un rol derientador en la terapia y no de experto, permitiendo lamergencia de la experiencia del consultante y abriendo unorizonte de posibilidades que busca la comprensión de laersona según su experiencia particular, reconociendo losecursos y potencialidades de las personas para que puedanprender a conocerse y autorregularse positivamente, asíomo aceptar que el sufrimiento es inevitable pero a la vezmpermanente, es decir, que no va a perdurar.

Finalmente, se reconoce una categoría que integra la opi-ión de los participantes con respecto al tipo de terapia quee genera cuando ellos llevan una práctica de meditación.rincipalmente, refieren que se trata de una terapia más fle-ible, en donde las intervenciones no intentan ser perfectas,ino que intentan ser genuinos al momento de conversar yo tan enfocados en los diagnósticos que deban elaborar.ambién, por el modo de ser que ellos tienen, se refieren

que es una terapia más consciente que busca conocerl otro en profundidad y que, además, se trata de un pro-eso de crecimiento, tanto para el consultante como paral terapeuta.

nálisis relacional

iguiendo las directrices de la Teoría Fundamentada (Glaser Strauss, 1967), se realizó el análisis relacional en 2 etapas.

odificación axialegún la experiencia de los colaboradores, en la figura 1 se

bservó entre «presencia» y «apertura», reconociendo quembos aspectos pueden influir en el modo de ser de unaersona en los distintos ámbitos de su vida.


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Figura 1 Esquema de la relación entre presencia y apertura.

El sentido de este movimiento comienza desde el vértice,que representa el estar centrado y presente a partir de larespiración. Esto generaría un estado que puede influir enla manera en que perciben lo que van viviendo, pudiendo«abrir» o «cerrar» nuestra capacidad para percibir más omenos los distintos estímulos que van ocurriendo, ya seande experiencias externas o internas de la persona (p. ej.,emociones, pensamientos, sensaciones corporales).

Con respecto a la figura 1, desde el estar presente y cen-trado corporalmente, es posible que este compás se abraen mayor o menor medida, co-existiendo como un inter-cambio que genera transformación en la persona, ya queinfluiría directamente en qué tan receptivo puede estar conla experiencia. Pareciera que «estar presentes» se conectacon «estar en apertura», cuando desde el «darse cuenta» y«estar focalizado» se desarrolla en la persona una actitudreceptiva y de aceptación hacia la experiencia, requiriendo
de esta que se encuentre con una intencionalidad en elpresente.
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Figura 2 Doble dimensión de la presencia psicoterapéutica.

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En la figura 2 se ilustra el significado de presencia, susomponentes y la manera en que estos se influyen mutua-ente.Estar presente es entendido por los participantes como

star enfocado, tomando consciencia de cómo se vive.lantean que se trata de un proceso constante en el queractican una respiración consciente, pudiendo reconocer suropia conexión con la experiencia fenomenológica, inclu-endo en esto su cuerpo, sus emociones y pensamientos,levando el «darse cuenta» al momento presente. Esto seincularía con reconocer la posibilidad permanente de que,n el aquí y ahora, nos encontremos con la experiencia,stando disponibles para lo que ocurra.

Según los relatos, se identificaron 2 componentes rele-antes de esta presencia:

. Estar dándose cuenta ----o ser auto-conscientes---- de cómose vive, pudiendo reconocer cuando su mente está cen-trada en sus propios pensamientos e interpretacionesde la experiencia. Reconociendo esta influencia y pres-tando atención a lo que ocurre desde una reflexióny observación no-tradicional, los participantes refierenque podrían «estar con lo que sea que ocurra», sin emitirjuicios automáticamente.

. El otro componente es estar focalizado. Los terapeu-tas consideran que la meditación, desde su método,favorece la capacidad de estar enfocado en lo que vaocurriendo, ya que la conciencia estaría en sincronía conel movimiento del cuerpo, estando con los sentidos dis-puestos y focalizados en los sucesos que van ocurriendo.Estar focalizado en el presente implicaría entonces unacoordinación entre el cuerpo y la mente. Esto quieredecir que junto a la capacidad de darse cuenta, a partirde la respiración se lograría salir del flujo automático delos pensamientos para así captar y guiarse por el flujode la experiencia, pudiendo identificar cuándo es que lamente se proyecta por sobre este flujo. Así, gracias a laatención, sería posible hacer el ejercicio de «ir y venir»,de involucrarse en un movimiento que nos invita a volveral momento presente, para encontrarnos centrados cor-poralmente y receptivos con respecto a sea lo que seaque vaya ocurriendo.

Con esto, desde el estar presente, se generaría un estadoe conexión con lo que ocurre, ya que conecta a la per-ona con los sucesos del mundo, desde la respiración, siendoste el punto donde co-emerge su relación íntima con elenómeno de la apertura, representado en la figura 3.

Apertura se trataría de una actitud de estar recep-ivo y abierto, teniendo la posibilidad de «estar con» laxperiencia, sin la necesidad de anadir juicios u opinionesutomáticas que modifican nuestro comportamiento. Algu-os participantes relacionan esta actitud con poder «estarbierto desde el corazón», es decir, intencionándose a aco-er con amabilidad y paciencia lo que ocurra, especialmentea incomodidad o el malestar. Según sus experiencias, estarn apertura implicaría además que se comienza a distinguira sutileza de los encuentros, los mensajes que se presentan
ras el contenido explícito de lo que se dice o se hace.
Sobre la apertura, esta se caracterizaría por 4 factoresue constantemente se ponen en contacto (figura 3) y que seelacionan con estar de tal modo que no se emiten juicios de

90 M.F. Silva Soler, C. Araya-Véliz

Presentey centrado

corporalmente

Sí mismo

Experiencia

No emitir juiciosAmabilidad

(Am)

Mente de

principiante

(MP)

Atención a lo que

ocurre en el

momento

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(NJ)

Características

Otros

Focalizado en lo que ocurra

A

¿Cómo estoy?

e la

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Figura 3 Características d

anera automática, sino que se está con amabilidad, atento lo que ocurre y con una mente curiosa, de principiante,ue acoge el no-saber como una posibilidad de aprendizajeonstante y no como una limitante. Es aquí donde «estarbierto desde el corazón» implica aceptar también la imper-anencia de la incomodidad, pudiendo flexibilizar la mente,

stando abiertos desde la aceptación.Desde el estar presente y centrado corporalmente, la

pertura implicaría una posibilidad para abarcar lo que fuedentificado como 3 dimensiones diferentes pero conectadasntre sí: 1) Apertura consigo mismo, que implica la auto-onciencia que surge desde el estar presente y el darseuenta de ¿cómo estoy?, ¿qué siento ante esto que estáasando?, ¿cómo me estoy cuidando? 2) Apertura hacia nues-ra experiencia. Esta se vincula con la capacidad de estaron lo que sea que vaya ocurriendo, pudiendo acoger y estaron los sucesos sin que intervengan los pensamientos auto-áticamente, promoviendo un actuar más genuino y amable

nte lo que ocurra. 3) Apertura con los demás, que implicaantener una actitud receptiva y abierta en el encuentro

on las demás personas también, pudiendo estar ahí de unaanera más amable y con aceptación.Estas dimensiones no son fijas, ya que se trata de un

roceso constante de auto-conocimiento y trabajo personal,ero parecen ser fundamentales para entender cómo es queresencia y apertura han influido en el modo de hacer tera-ia que tienen los participantes de este estudio. Esto, yaue consideran que en psicoterapia es fundamental abrir unspacio para el otro, pudiendo honrar su presencia y estarn apertura para acompanar los procesos que se presenten,enerando un espacio de confianza para conversar.

Considerando los relatos, observamos que en el espacioerapéutico se abre la posibilidad de cultivar una co-resencia terapéutica (fig. 4). Esta ha sido entendida aleconocer la influencia que la práctica de meditación ha

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apertura psicoterapéutica.

enido tanto en su modo de situarse al momento de hacererapia (y el rol que se adjudica como terapeuta), como enl vínculo que se establece con el consultante y la influenciae este en el proceso de la terapia.

Al momento de hacer terapia los terapeutas intentanosicionarse de tal manera que sean capaces de acogerl otro y sus experiencias a partir de la apertura quellos viven, tanto consigo mismos como con la experiencia,aciendo el esfuerzo de estar atentos, presentes y empáti-os al momento de conversar. Desde su modo de ser, refierenue intentan movilizarse desde la aceptación y confianza enl otro, buscando explorar las experiencias del consultante,reguntándose ¿quién es esta persona? Así, se configurarían tipo de terapia caracterizada por acoger la vulnerabili-ad y la inseguridad o el no-saber, explorando y aceptandostas vivencias y brindándoles un espacio seguro para quee presenten y, eventualmente, se transformen.

Esta posición ----o actitud---- del terapeuta influiría en cómoe siente el consultante en psicoterapia, ya que también lonvita a estar más presente en el espacio terapéutico, desdeu modo de relacionarse. Se reconoce una co-presencia que,or el solo hecho de estar ahí juntos, se vuelve terapéutica.sto no significa que necesariamente se realizarán prácticase meditación con el consultante, ya que la mayoría de loserapeutas no lo hacen, a excepción de ciertos casos, peroí se genera una influencia implícita por el hecho de quel terapeuta se sitúe desde un estado de presencia, ya quenvita al otro a estar ahí y conversar de una manera distinta.sta co-presencia quiere decir que, desde el modo de ser delerapeuta durante la terapia, se puede facilitar el trabajolínico para alcanzar una mayor profundidad a partir de la
omprensión que se va generando con el otro. Esto influiríae tal manera que los psicoterapeutas refieren un cambio ena apertura de los consultantes, ya que comenzarían a rela-ionarse con sus problemas desde la aceptación, pudiendo

Mindfulness en contextos psicoterapéuticos 91

Relación terapéutica: Cualidad de la dimensión relacional

Terapeuta

Invitación

a estar

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Consultante

PP

Apertura vivida por elterapeuta:

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Se acoge

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Efecto:Conocerse mejor y

sentirse tranquiloConfiar en que puede

auto-regularse

Aceptación del síntoma y

de sí mismo

Dimensión relacional:Co-Presencia

Escucha atenta y empática

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ser ¿quién es?

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Figura 4 Dimensión relacional de la

conocerse mejor, confiando en que es posible autorregularsey que la incomodidad es impermanente, es decir, que no vaa perdurar para siempre y que el cambio es posible.

Codificación selectiva

En la codificación axial se intentó mostrar cómo es que lospsicoterapeutas entrevistados entendían la presencia y laapertura por separado. Sin embargo, juntos configuran unaunidad que tiene un efecto significativo en el modo de serde la persona del terapeuta, influyendo cómo este percibey se relaciona con las distintas cosas que ocurren. Un temarelevante respecto a estos fenómenos se relaciona con lainfluencia que uno tiene sobre el otro y en qué punto, alestar co-determinados, comienzan a co-existir, siendo esteel punto de inicio para la teoría emergente propuesta. Lanecesidad de considerar esta distinción se vuelve intere-sante e importante al querer delimitar en cierta medida elrango de alcance que presencia y apertura tienen por sí mis-mos, siendo fundamental para alcanzar una descripción másminuciosa de los fenómenos y así lograr responder a la pre-gunta y a los objetivos planteados para esta investigación.Con esto, la codificación selectiva propone una observaciónde la relación que existe entre presencia y apertura simul-táneamente, considerando la influencia que esto tendría enlos psicoterapeutas y en su modo de ser.

Las características de presencia (estar focalizado y dán-dose cuenta) muestran una aparente co-determinación conlas características de estar en apertura (no juzgar automá-ticamente, estar con amabilidad, mantener una mente de
principiante y estar atento a la experiencia), en el sentidode que a partir de la presencia se permitiría esta apertura,y que estar en apertura implica por su parte un procesoconstante de volver a estar presente.
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ncia: emergencia de la co-presencia.

Se considera con lo anterior que la práctica de meditaciónavorece estar con una presencia abierta, que incluye dentroe su rango de apertura a las distintas dimensiones relacio-ales, que en mayor o menor medida generan un movimientoel compás presentado y que se manifiestan en el modo conue se está en el día a día y no solo durante la prácticae meditación. En este sentido, se reconoce la posibilidade estar abierto en 360◦, puesto que implica incluirse a síismo de manera transversal en esta apertura y no solo a

a experiencia externa, estando siempre presente la posi-ilidad de que este «grado de apertura» cambie según lasxperiencias de vida y procesos personales.

A partir de esta observación fue posible vislumbrar mejorquella comprensión profunda que los participantes mencio-aban y que era consecuencia de la práctica de meditación.sto se basa en que los relatos dan cuenta de un sentido pro-undo tras la relación entre ambos fenómenos, volviendoifícil al comienzo la tarea de diferenciar a cada uno poreparado, puesto que al descubrir que ambos co-emergen,

partir del estar centrado, implica que no solo se relacionan vinculan entre ellos, sino que co-existen y constantementeon co-originarios de una influencia muy característica quee vincula con un modo de ser-en-el-mundo. Esto significaue se pasa a considerar a ambos fenómenos como uno solo,n donde a partir de estar centrado y posicionado con pre-encia abierta, se configura desde una técnica (meditar ystar atento a la respiración) un modo de ser-en-el-mundo,ue es integrado y se presenta de manera transversal en losistintos momentos del día a día de la persona. Con respecto

esto, un participante plantea lo siguiente: «en los esque-as como más tradicionales parece que meditar es como
istinto de estar en la forma habitual de ser en el mundo. Enambio, si se habita el ser, el mundo y lo psicológico como sino dijera existencialmente como lo ‘‘existenciario’’, comoue uno existe en-el-mundo de esa manera. Se ilumina como

92 M.F. Silva Soler, C. Araya-Véliz

P A Modo de seren el mundoPosicionado con

presencia abierta

Experiencia

360º 0º

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Figura 5 Presencia terapéuti

esde adentro, no como un anadido» (entrevistado II, líneas76-179).

Plantear que la influencia de la presencia abierta se con-gura como un modo de ser en el mundo (fig. 5) se debe

que la práctica constante de meditación es consideradaor los colaboradores de este estudio como un cambio en laanera de estar y de relacionarse que tienen con ellos mis-os y con los demás. Esto influiría en su modo de estar con

a experiencia debido a que comenzarían a desarrollar unacomprensión profunda» con respecto a la vida, llevándolos

observar y actuar de un modo diferente al que acostum-raban antes de la práctica, implicando un cambio en suodo habitual de ser que los conecta con un estado de bie-

estar personal. Por esto, se entiende como resultado quelcanzan una comprensión diferente sobre su rol como psi-oterapeutas y del sentido que dan a la psicoterapia, lo quenfluencia su modo de ser y de relacionarse en estos espa-ios, así como también su disposición ante el encuentro. Algudizar tanto su conexión y presencia en ese aquí y ahoraambia su posición y su modo de moverse en ese estar ahí.

iscusión

os resultados de esta investigación dan paso a una reflexiónn torno a lo que tradicionalmente se define como lo quedebiese ser y hacer el terapeuta» y el rol que este tiene ensicoterapia, viéndolo desde la influencia que tiene el tera-euta y lo que se permite ----o no---- hacer, sentir o pensarobre la terapia, el consultante y el vínculo que se man-iene con ellos. Este sería un aspecto fundamental que see influido cuando el terapeuta comienza a llevar una prác-ica constante de meditación, ya que, como se observó, estaarece cambiar el modo habitual de ser de los terapeutas,o que incluye su ejercicio profesional.

La capacidad de acoger la vulnerabilidad desde la auto-ompasión es una característica fundamental del modo deer de estos terapeutas. Esto parece surgir desde un sen-ido de no-omnipotencia, que permitiría acoger el malestar,

yeet

mo modo de ser en el mundo.

rindándole un espacio para expresarse, pero sin dejarloomo parte estática de la identidad de la persona. Esto seincula con lo referido por Brito (2011), al mencionar quea atención plena nos ayuda a no quedarnos en estados aní-icos o formas de pensar que se apegan a la estrechez de

uestros sufrimientos, pudiendo abrirnos al devenir de laida desde un modo de ser que fomenta nuestra lucidez ypertura. En psicoterapia sería como resignificar los roles delerapeuta y consultante, así como el modo de hacer tera-ia, generando una comprensión y proceso de cambio ques más compartido que dirigido, más dialógico que monoló-ico y más exploratorio de posibilidades que centrado en uniagnóstico fijo.

Esto sería como volver disponible la experiencia de estarhí con el otro, reconociendo efectivamente que se estáhí con el otro. Co-presencia terapéutica podría entenderseomo un encuentro entre 2 presencias diferentes, las queueden tener grados de apertura distintos y que se confi-uran como 2 modos de ser-en-el-mundo diferentes que sencuentran dentro del marco de la terapia, con el fin deo-construir una comprensión significativa respecto a lo quemerge del proceso, sin polarizar la influencia entre quienesarticipan del espacio terapéutico.

Esto es coherente con una intención posmoderna sensi-le a lo relacional, que toma los procesos conversacionales

dialógicos como un medio de co-construcción de signifi-ados, vinculándose con el otro, a partir de una intenciónenuina de estar ahí, desde la curiosidad y la confianza enos conocimientos que el consultante tiene respecto a suropia vida, lo que permite confiar también en el aprendi-aje que puede surgir cuando los terapeutas se sitúan desden espacio de flexibilidad y de no-omnipotencia (Gergen,001; Anderson, 2007). Así, podría acercarse el concepto deo-presencia a la psicología, como un modo de comprenderue, en primera instancia, se trata de personas distintas

que, además, nos vemos unidos por una complicidad despecie, por una humanidad compartida o complicidad despecie que nos permite reconocernos, aceptando las distin-as experiencias y moviéndonos desde una empatía afectiva

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al comprender que ciertas cosas (como el malestar) son ine-vitables, pero sí podemos cambiar el modo de relacionarnoscon ellas.

Esto último podríamos verlo como una forma de cambiarla manera en que, día a día, nos intencionamos desde nues-tros pensamientos y emociones, a la experiencia. Como unaposibilidad de reconocer nuestra capacidad de re-crearnosy vivir en nuestro presente con una actitud de apertura yparticipación activa (siendo autores de nuestro presente),para así dirigirnos y manifestar para nuestra vida aquelloque nos hace sentido, reconociendo también los cambiosque podríamos generar en nuestro modo habitual de ser y loshábitos que podríamos cultivar para alcanzar un estado debienestar personal y de auto-cuidado dentro de un ambienterelacional.

Posiblemente, la práctica de «centrarse» y estar desdeuna presencia más abierta también sería un aporte paraalcanzar una coherencia teórico-práctica con respecto ala postura filosófica del construccionismo social (Anderson,2007), ya que, si bien plantean la importancia de conside-rar a esta filosofía como un modo de vivir, en lo concretono siempre es fácil guiarse desde este modo de ser y decomprender las distintas experiencias cuando somos partede un sistema acostumbrado a moverse desde un «pilotoautomático».

Con estas reflexiones esperamos aportar a continuarconociendo sobre estos estados y la influencia positiva quetienen para el bienestar de las personas, tanto individualcomo colectivo, y en nuestro trabajo como psicoterapeu-tas. Dar luz a su carácter innato nos permite re-conocernosy re-conectarnos con la experiencia, con nuestra humanidadcompartida, con la capacidad para adquirir herramientaspara nuestro autocuidado, potenciando aspectos como lacompasión, la aceptación y el tomar consciencia del modocon que se dirige la intención en el día a día. Lo que significauna gran oportunidad para cambiar el modo habitual de ser,tomando una participación activa respecto a nuestra propiavida y a los cambios que deseamos manifestar.

Este estudio presenta algunas limitaciones que debenser consideradas. Al ser solamente 9 los entrevistados, seentiende que estos resultados no son representativos nigeneralizables, dada la subjetividad que implica conside-rar sus experiencias personales, pero sí es un medio útilpara conocer nuevas perspectivas y generar reflexiones alrespecto, reconociendo que la meditación sentada no esel único medio para estar presentes. La muestra tampocoestá balanceada, por lo que se invita a que próximas inves-tigaciones pudiesen tomar una perspectiva más integral conrespecto a la mayor cantidad de posturas psicoterapéuticas,para así enriquecer aún más la reflexión realizada.

También sería necesario conocer la experiencia de tera-peutas que no están muy familiarizados con respecto a lameditación, para brindar una perspectiva mayor acerca delo que los psicoterapeutas entienden por estar presentes yen apertura con el consultante y la importancia que dan aeste tema, así como las distintas formas que tienen paracentrarse y poder estar ahí con los otros.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

W

93

ibliografía

nderson, H. (1999). Conversación, lenguaje y posibilidades. Unenfoque posmoderno de la terapia. Buenos Aires: Amorrortu.

nderson, H. y Goolishian, H. (1988). Human systems as linguisticsystems: Evolving ideas about the implications for theory andpractice. Family Process, 27, 371---393.

nderson, H. (2007). A postmodern umbrella: Language and know-ledge as relational and generative, and inherently transforming.En H. Anderson y D. Gehart (Eds.), Collaborative Therapy: Rela-tionships and Conversations That Make a Difference (pp. 7---20).Nueva York: Taylor & Francis Group.

raya, C. (2010). El mayor avance es detenerse. Santiago: MagoEditores.

raya, C. y Arístegui, R. (2015). Pasos hacia un bienestar relacional:Mindfulness como un espacio de relación con otros. En D. Duharty D. Sirlopú (Eds.), Bienestar y espiritualidad: Diálogos desde lapsicología, la filosofía y la sociología (pp. 61---72). Santiago deChile: UDD Publicaciones.

rito, R. (2011). Habitar poético y presencia ---- atención plena(mindfulness): un diálogo entre Occidente y Oriente. PsiquiatríaUniversitaria, 7, 309---317.

rown, K. y Ryan, R. (2003). The benefits of being present: Mind-fulness and its role in psychological well-being. Journal ofPersonality and Social Psychology, 84, 822---848.

urgess, S., Propper, C. y Wilson, D. (2005). Extending choice inEnglish health care: The implications of the economic evidence.London: Centre for Economic Policy Research.

arlson, K., Silva, S., Langley, J. y Johnson, C. (2013). Mindful-Veteran: The implementation of a brief stress reduction course.Complementary Therapies in Clinical Practice., 19(2), 89---96.

spinoza, V. y Gutiérrez, J. (2012). Percepción sobre el impactode la práctica personal de Mindfulness en las habilidadesterapéuticas posmodernas [tesis de maestría]. Santiago, Chile:Universidad Adolfo Ibánez.

arland, E., Gaylord, S. y Park, J. (2009). The role of mindfulnessin positive reappraisal. Explore, 5(1), 37---44.

ergen, K. (1996). Realidades y relaciones: Aproximación a la cons-trucción social. Barcelona: Paidos Ibérica.

ergen, K. (2001). La terapia como construcción social: Dimen-siones, deliberaciones y divergencias. Sistemas Familiares., 17,11---28.

ergen, K. y Hosking, D. (2006). If you meet Social Constructionalong the road. . . A dialogue with Buddhism. En M. Kwee, K.Gergen, y F. Koshikawa (Eds.), Horizons in Buddhist Psychology(pp. 1---20). Chagrin Falls, OH: Taos Institute Publications.

ermer, C., Siegel, R. y Fulton, P. (2005). Mindfulness and Psychot-herapy. New York: Guilford Press.

laser, B. y Strauss, A. (1967). Discovery of Grounded Theory. Stra-tegies for Qualitative Research. Chicago: Aldine Pub.

abat-Zinn, J. (1990). Mindfulness en la vida cotidiana: Dondequiera que vayas, ahí estás. Barcelona: Paidós.

rause, M. (1995). La investigación cualitativa: un campo de posi-bilidades y desafíos. Revista Temas de Educación, 7, 19---39.

afran, J. y Muran, J. (2000). Negotiating the therapeutic alliance:A relational treatment guide. New York: Guilford.

imón, V. (2007). Mindfulness y Neurobiología. Revista de Psicote-rapia, 17(66-67), 5---30.

tagoll, B. (1993). Aspects of family therapy. Current Opinions inPsychiatry, 6, 343---347.

uzuki, S. (1970). Zen Mind, Beginers Mind. New York: Weatherhill.arragona, M. (2006). Las terapias posmodernas: una breve intro-

ducción a la terapia colaborativa, la terapia narrativa, y laterapia centrada en soluciones. Psicología Conductual, 14(3),
511---532.
illiams, M., Teasdale, J., Segal, Z. y Kabat-Zinn, J. (2007). Vencerla depresión. Descubre el poder de las técnicas del mindfulness.New York: The Guilford Press.












































































































































































































































































































































































































































































































































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mbulatório de mindfulness e promocão da saúde:elato de experiência

era Lúcia Morais Antonio de Salvoa, Érika Leonardo de Souzaa,inicius Terra Loyolaa, Marcelo Batista de Oliveiraa, Marcio Sussumu Hirayamaa,aria Lúcia Favaratoa, Daniela Ferreira Araújo Silvaa, André Martins Monteiroa,eandro dos Reis Lucenaa, Patricia Silveira Martinsa,icardo Monezi Julião de Oliveiraa, Tatiana Berta Oteroa,avier Garcia Campayob e Marcelo Marcos Piva Demarzoa,∗

Mente Aberta - Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo, São Paulo, BrazilMáster en Mindfulness, Universidad de Zaragoza, Zaragoza, Espanha

ecebido a 20 de maio de 2016; aceite a 5 de setembro de 2016isponível na Internet a 25 de novembro de 2016

PALAVRAS-CHAVEMindfulness;Promocão da saúde;Autocuidado

Resumo O objetivo deste trabalho foi descrever a experiência e o perfil dos usuários doambulatório de mindfulness e promocão da saúde de uma universidade pública. O perfil dosparticipantes foi obtido a partir da aplicacão de diferentes escalas psicométricas (BDI, SUBI,MAAS e EUROQOL 5 D), bem como informacões sociodemográficas e de saúde. A descricão daexperiência do ambulatório foi realizada a partir da técnica SWOT. Nesta amostra, o perfilencontrado foi predominantemente feminino, com plano de saúde e assistência médica regu-lar. Apesar dos problemas relatados, a percepcão subjetiva de qualidade de vida ficou acimada média. Pertencer a uma universidade pública, contar com equipe multiprofissional e faci-litadores de distintas formacões em mindfulness, além de local de fácil acesso, são pontosfortes deste ambulatório, bem como a alta prevalência de ansiedade e depressão, que podemoportunizar a expansão desta atividade.© 2016 Mindfulness & Compassion. Publicado por Elsevier Espana, S.L.U. Todos os direitosreservados.

KEYWORDS Outpatient clinic of mindfulness and health promotion: experience report

study was to describe the experience and the profile of users of anlness and health promotion from a public University in Brazil. Theas obtained from the application of different psychometric scales

Mindfulness;Health promotion;Self-care

Abstract The aim of this

outpatient clinic of Mindfuprofile of the participants w
(BDI, SUBI, MAAS and EUROQOL 5 D), as well as socio-demographic and health information. The
∗ Autor para correspondência.Correio eletrónico: [email protected] (M.M. Demarzo).

ttp://dx.doi.org/10.1016/j.mincom.2016.10.002445-4079/© 2016 Mindfulness & Compassion. Publicado por Elsevier Espana, S.L.U. Todos os direitos reservados.






Minfulness y promocao de salud 95

description of the experience of the clinic was held from the SWOT technique. In thissample, the profile found was predominantly female, with health insurance and medical care.Despite the problems reported, the subjective perception of quality of life was above average.Belong to a public University, rely on multidisciplinary team and facilitators of different con-figurations in mindfulness, plus easily accessible location are strengths of this clinic, as wellas the high prevalence of anxiety and depression, which can enhance the expansion of thisactivity.© 2016 Mindfulness & Compassion. Published by Elsevier Espana, S.L.U. All rights reserved.

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Introducão

A promocão da saúde pode ser compreendida de formamultidisciplinar, integrada, objetivando mudancas na assis-tência à saúde, bem como na gestão local de políticaspúblicas e está associada a valores como: vida, saúde, soli-dariedade, equidade, entre outros (Carvalho, 2008).

A promocão à saúde moderna constitui, nos dias de hoje,um dos principais modelos teórico-conceituais que subsi-diam políticas de saúde em todo o mundo (Carvalho eGastaldo, 2008); pode ainda ser compreendida como qua-lidade de vida e bem-estar na sociedade (Demarzo, 2012).

A promocão da saúde envolve ainda o desenvolvimentode habilidades individuais que podem permitir a tomada dedecisões favoráveis à qualidade de vida e à saúde; o que serelaciona com o empoderamento, um dos conceitos estrutu-rantes da promocão à saúde e autocuidado. Os programas demindfulness vêm de encontro à promocão da saúde, pois têmcomo princípio o desenvolvimento de autonomia e empode-ramento das pessoas por meio do treinamento da atencãoplena (Demarzo, 2015), podendo aumentar a autoeficáciaem saúde do indivíduo, definida como crenca que uma pes-soa pode ter sobre sua capacidade de organizar e executaruma acão para um comportamento bem-sucedido, obje-tivando resultado específico (Silva e Lautert, 2010). Essacrenca impulsiona o indivíduo para a acão. Assim, apesarda compreensão da magnitude do conceito de promocão desaúde e tudo o que ela envolve além do indivíduo, optou-se,neste trabalho, por focar a promocão de saúde no âmbitoindividual, no contexto de autocuidado e autoeficácia.

Programas de autocuidado baseados emmindfulness

A palavra mindfulness (traduzida como atencão plena) podeser definida como uma característica ou estado psicológico,ou ainda exercícios e práticas as quais são, em sua maioria,derivadas de práticas meditativas tradicionais, adaptadasprincipalmente do Zen Budismo, do ioga, e da tradicãoVipassana (Demarzo, 2015), nos quais se foca a atencão naatividade realizada no momento presente (Keng, Smoski eRobins, 2011).

A definicão mais tradicional de mindfulness é a de Kabat-
-Zinn (1982), como uma habilidade metacognitiva de prestaratencão de forma intencional, no momento presente, semjulgamento. A partir dessa definicão muitas outras surgiram;algumas das definicões mais recentes são de Chadwick et al.
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2008), que divide mindfulness em 4 componentes: 1) cons-iência descentrada; 2) sustentar e permitir que a atencãoepouse mediante situacões cognitivas difíceis ou que geremofrimento; 3) aceitacão de pensamentos e imagens difíceis;

4) permitir que aspectos cognitivos de difícil manejo pas-em sem reacão por parte da pessoa. Já Feldmann, Hayes,umar, Greeson e Laurenceau (2007) traduzem mindfulnessomo sendo a vontade e capacidade para ser igualmenteresente em todos os eventos e experiências com discerni-ento, curiosidade e gentileza.A partir do conceito de mindfulness foram criados

rotocolos de intervencões baseados para aplicacão emopulacões clínicas. O primeiro desses protocolos foi oindfulness-Based Stress Reduction (MBSR), na década de0, desenvolvido por Kabat-Zinn, na Universidade de Massa-husetts, para intervencão em populacão que apresentasseíveis elevados de estresse.

De acordo com Ludwig e Kabat-Zinn (Ludwig e Kabat-Zinn, 2008), o programa baseado em mindfulness podenfluenciar a capacidade do indivíduo em se recuperar deeficiências e doencas, diminuindo a percepcão da intensi-ade da dor; aumentando a capacidade de tolerar a dor ouncapacidade; reduzindo o estresse, ansiedade ou depres-ão; reduzindo o consumo e, desse modo, minimizandofeitos adversos de analgésicos, ansiolíticos ou medicacãontidepressiva; reforcando a capacidade de refletir sobrescolhas em relacão a tratamentos médicos; melhorando

aderência ao tratamento medicamentoso; aumentando aotivacão para a mudanca de estilo de vida que envolveieta, atividade física, relacões interpessoais, além daessacão do fumo e outros comportamentos não saudáveis;

promovendo alteracões nas vias biológicas que afetam aaúde (sistema nervoso autônomo, sistema imunológico euncão neuroendócrina).

Pesquisas sugerem que as intervencões baseadas emindfulness tem efeitos positivos em casos de depressão

Fortney, Luchterhand, Zakletskaia, Zgierska e Rakel, 2013;owells, Ives-Deliperi, Horn e Stein, 2012), além de ansie-ade e estresse (Gotink et al., 2015; Khoury et al., 2013).

indfulness e atencão primária à saúde

s custos para tratamento de doencas são elevados; noaso da saúde mental inclusive, o tratamento farmacoló-ico agrega inúmeros efeitos colaterais indesejáveis. Nesteentido, promover a saúde utilizando um programa baseado

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m mindfulness tem o potencial de ser custo efetivo, pro-ovendo efeitos diretos e indiretos na saúde do indivíduo.Os grupos de mindfulness (atencão plena) e promocão

a saúde do departamento de medicina preventiva destaniversidade pública são voltados a pacientes com níveisrejudiciais de estresse e/ou portadores de doencas crô-icas como ansiedade, depressão, hipertensão, diabetes,besidade, câncer e dor crônica de origem diversa. O pro-rama é desenvolvido ao longo de 8 semanas, uma vezor semana por aproximadamente 2 horas, para vivência

trocas de experiências sobre as técnicas de mindfulness,aseadas em exercícios para focar a atencão no presente.

O programa de mindfulness ofertado está baseado emlementos do programa MBSR (Demarzo, 2011), em que sãorabalhados os exercícios da «uva passa», a atencão plena naespiracão breve (3 minutos), bem como a versão completa,

«escaneamento» corporal e os movimentos corporais comtencão plena, consideradas as principais técnicas de mind-ulness.

Apesar da relevância do tema, dos resultados promis-ores desta ferramenta como adjuvante de tratamento eromocão da saúde, são escassos os estudos sobre o perfile participantes de programas baseados em mindfulness norasil. Assim, objetivou-se descrever a experiência e o perfilos usuários do ambulatório de mindfulness e promocão daaúde de uma universidade pública.

étodo

rata-se de um relato de experiência, que utilizou, paraescricão do ambulatório, a análise SWOT, que é umcrônimo das palavras Strengths, Weakenesses, Opportu-ities e Threats. Ela é dividida em 2 partes: o ambientexterno à organizacão (oportunidades e ameacas) e o ambi-nte interno (pontos fortes e pontos fracos). Serve comorientacão estratégica, permitindo amenizar o eliminar deraquezas; identificar oportunidades a partir de seus pontosortes; corrigir pontos fracos em que se vislumbre opor-unidades potenciais, monitorando pontos fortes a fim de,uturamente, não ser alvo de riscos e incertezas (Travassos

Vieira, 2011).O universo amostral foi constituído por pacientes pro-

enientes do ambulatório de promocão de saúde de umaniversidade pública de São Paulo. Todos os pacientes quearticiparam do ambulatório de promocão de saúde, noeríodo de junho de 2014 até junho de 2015, foram sele-ionados para fazer parte deste estudo.

Para ingressar no ambulatório, os candidatos são pre-iamente triados no ambulatório de saúde da família, aartir de entrevista clínica, com psicólogo, a fim de veri-car se podem ingressar no programa. São excluídas todass pessoas em fase aguda de depressão e esquizofrenia,ue apresentem transtornos psicóticos, ou que estejamazendo uso de medicamentos que causem prejuízos cog-itivos, atencionais e de concentracão.

Aqueles não elegíveis à participacão são encaminhados outros setores da universidade para tratamento, caso não
stejam recebendo acompanhamento. Aos que se enquadra-am nos critérios de inclusão é ofertada uma palestra intro-utória, com duracão de aproximadamente uma hora, emue se fornece esclarecimentos sobre mindfulness e como
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erá conduzido o programa. Ao final da mesma e novamenteo primeiro encontro, apresenta-se o Termo de Consenti-ento Livre e Esclarecido para cada um dos participantes.os que concordam participar da pesquisa, são entregues,o primeiro e último encontro, bem como a cada 6 meses doérmino do programa, uma série de questionários de auto-reenchimento (os mesmos questionários utilizados ao longoo acompanhamento) a fim de avaliar condicões de saúde,

estado de mindfulness, adesão às práticas e outras carac-erísticas importantes para o acompanhamento do impactoo programa ao longo do tempo. O preenchimento dos ques-ionários requer em média 40 minutos, e é realizado até onício do programa (baseline) e no último dia do mesmo (paravaliacão pós intervencão), presencialmente ou online.

nstrumentos

oram utilizados, para caracterizacão da amostra, avaliacãoa saúde física, psicológica, estado de mindfulness e quali-ade de vida, os seguintes instrumentos:

Questionário sociodemográfico e de perfil epidemioló-gico: contendo características sociodemográficas comoidade, sexo, assistência médica e problemas de saúde,física ou mental.

Inventário de depressão de Beck (BDI): instrumento demedida de intensidade de depressão composto por umaescala de autorrelato, de 21 conjuntos de itens, cada umcom 4 alternativas, subentendendo graus crescentes degravidade de depressão, com escores de 0-3 (Beck, Ward,Mendelson, Mock e Erbaugh, 1961). Este instrumento foivalidado no Brasil por Cunha (2001), com 5.000 casos.

Subjective Well-Being Inventory (SUBI): instrumento deavaliacão de autorrelato, que mede o grau de bem--estar subjetivo de um indivíduo em relacão a váriaspreocupacões do cotidiano (Nagpal e Sell, 1985).

Mindfulness Attention Awareness Scale (MAAS). A MAASapresenta uma estrutura unidimensional com 15 itens,sendo a escala de mindfulness mais utilizada nas pesquisasinternacionais sobre o tema e está validada para o Brasil(Barros, Kozasaka, Souza e Ronzania, 2015).

EUROQOL 5 D é uma medida padronizada de estado desaúde, desenvolvida pelo grupo EuroQol para forneceruma medida simples, genérica da saúde para avaliacão clí-nica e económica. É composto por um sistema descritivoe uma escala analógica visual. Este instrumento compre-ende 5 dimensões: mobilidade, autocuidado, atividadeshabituais, dor, desconforto e ansiedade depressão. Cadadimensão tem 3 níveis: sem problemas, alguns problemas,problemas graves (Ferreira, Ferreira e Pereira, 2013).

nálise dos dados

ealizou-se uma análise descritiva das variáveis contínuas,ediante medidas de tendência central e dispersão eas variáveis categoriais em frequência. Foram realizadas
orrelacões de Pearson entre as escalas BDI, de SUBI e MAAS,em como as correlacões entre a nota que o paciente deuara a saúde como um todo (EUROQOL 5 D) com os escoresas demais escalas. O nível de significância adotado foi de

Minfulness y promocao de salud 97

Tabela 1 Características dos participantes (n = 46)

Sexo*

Feminino 33 71,7Masculino 13 28,3

Plano de saúde*

Sim 34 73,9Não 12 26,1

Idade (anos) (DP)≤ 48 21 47,7 (6,3)> 48 23 52,3 (6,7)

Acompanhamento médico regular*

Sim 28 60,9Não 18 39,1

Presenca de doenca*

Psiquiátrica/psicológica 19 47,5Endócrina/metabólica 21 52,5Neurológica 03 5,4Outras 13 23,2

Tabela 2 Média e desvio padrão dos escores de escalaspsicométricas

Média DP SMin SMax

BDI 11,9 9,3 0 33,0SUBI 18,7 3,1 12,0 24,0MAAS 3,5 1,2 1,6 8,7

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p < 0,05. As análises foram realizadas no pacote estatísticoSPSS for Windows 22.0 (SPSS, Inc., Chicago, IL, EUA).

Este trabalho passou pelo comitê de ética da uni-versidade e foi aprovado com o número de CAE:43093115.8.0000.5505.

Resultados

O número de respondentes foi de 46 pessoas, sendo a mai-oria do gênero feminino (71,7%), adultos e conveniadoscom algum plano de saúde particular. Dentre as condicõesclínicas que os participantes apresentavam, destacaram--se doencas relacionadas a condicões psiquiátricas (33,9%),como depressão, ansiedade, transtorno afetivo bipolar,transtorno de personalidade e esquizofrenia; e as condicõesendócrinas e metabólicas (37,5%), como hipotireioidismo eclimatério. Os dados sociodemográficos da populacão foramdispostos na tabela 1.

A tabela 2 indica as médias e desvios-padrão das esca-las utilizadas. O BDI apresentou uma média de 11,9 pontos(depressão leve para moderada), o SUBI de 18,7, e o MAAS de
3,5. Além disso, as correlacões encontradas foram fortes esignificativas entre as escalas SUBI e BDI (r = -0,77, p < 0,01).Foram encontradas correlacões positivas entre a qualidadede vida e o bem-estar subjetivo (r = 0,54; p > 0,001), e
Tabela 3 Porcentagem dos níveis de gravidade nos 5 domínios do

Fator Sem problema (%)

Mobilidade 77,8

Cuidados pessoais 91,1

Atividades habituais 66,7

Dor/mal-estar 33,3

Ansiedade/depressão 28,9

DP: desvio padrão; SMax: score máximo; SMin: score mínimo.

orrelacões negativas entre a qualidade de vida e os escorese depressão (r = -0,51; p > 0,001).

Na tabela 3 apresenta-se o percentual dos níveis de gra-idade nos 5 domínios do EUROQOL 5 D. Dor/mal-estar ensiedade e depressão foram os problemas mais frequen-emente relatados. Quanto a nota que foi dada para a saúdeomo um todo, a média encontrada foi 69,23 (± 17,89; valorínimo 29 e 100). Essas notas foram divididas em quartis,

endo encontrada a nota 60 no percentil 25, a nota 70 noercentil 50 e a nota 84,25 no percentil 75. Apesar dos pro-lemas relatados pelos pacientes, a percepcão subjetiva daualidade de vida está acima da média.

Verifica-se na tabela 4 a análise SWOT do ambulatório deutocuidado e promocão de saúde baseado em mindfulness,m que se verificam 2 oportunidades, 2 ameacas, 5 pontosortes e igual número de pontos fracos.

Realizando-se a análise cruzada do SWOT foi possívelazer as seguintes combinacões:

Forcas X ameacas: a multiplicidade de protocolos em mind-fulness pode comprometer o número de pessoas avaliadaspara análise dos resultados.Forcas X oportunidades: neste momento, mindfulness vemsendo alvo da mídia em geral, promovendo o maior acessodas pessoas ao programa, ainda que motivadas muitasvezes pela curiosidade apenas.Fragilidades X ameacas: a falta de políticas públicas difi-culta o acesso e, principalmente, o encaminhamento depacientes pelos próprios profissionais do atendimento pri-mário à saúde ao ambulatório, por desconhecimento doservico ou pelo encaminhamento não fazer parte da rotina.Fragilidades X oportunidades: a utilizacão da mídia podeaumentar o número de pessoas curiosas que procuramo servico, tornando necessária a utilizacão de instru-mentos de triagem mais específicos, bem como critérios
de exclusão rigorosamente definidos, a fim de atingir opúblico-alvo.
EUROQOL 5 D, (n = 45)

Algum problema (%) Problema grave (%)

22,2 08,9 0

33,3 062,2 4,457,8 13,3

98 V.L. Salvo et al.

Tabela 4 Análise SWOT do ambulatório de mindfulness e promocão de saúde

Análise externa

OportunidadesUtilizacão da mídia para captacão de público-alvoAumento da prevalência de depressão e ansiedade napopulacão, bem como excesso de peso e outras doencascrônicas

AmeacasMultiplicidade de visões para cuidados integrativos, faltade políticas públicasA falta de conhecimento sobre a ferramenta e os trâmitesutilizados pode gerar falsas expectativas sobre condutas,procedimentos e resultados, derivados da própria condicãoclínica dos participantes, que podem ter uma escuta parcialdas informacões fornecidas

Análise internaForcasPertencer a uma universidade pública, possuir uma equipemultiprofissional, contar com instrutores de diferentesformacões em mindfulness para ofertar esta ferramentaem diferentes formatos segundo característica do grupo;a maior parte dos pacientes triados no ambulatórioprocura o servico, realmente, com a expectativa dealcancar alívio para suas dores físicas ou emocionais,melhora na saúde e maior qualidade de vida

FragilidadesNão preenchimento ou preenchimento incompleto das escalas;heterogeneidade do grupo quanto às características clínicas;faltas dos participantes ao longo do programa e no follow-upFalta de comprometimento com o processo e desmotivacãoquanto a realizacão das práticas em casa, pois só dependemdo próprio participante e requerem disciplina

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procura pela atencão primária à saúde apresenta uma dis-repância entre os gêneros (Figueiredo, 2005), devendo ascassa presenca masculina, 28,3% neste estudo, ser moti-ada, em parte, por barreiras sócioculturais, onde o cuidado

visto como prática feminina e o autocuidado poderia ferir imagem de virilidade masculina, além do medo da des-oberta de alguma doenca grave (Gomes, Nascimento eraujo, 2007).

A intensidade e a duracão da depressão determinam aravidade da mesma, sendo a depressão leve, normalmentecompanhada por 5 sintomas, e a moderada acompa-hada por mais de 5 sintomas (Santiago e Holanda, 2013).m média, a populacão caracterizou-se com nível leve aoderado de depressão, segundo BDI, o que já poderia com-rometer a qualidade de vida dos participantes.

A prevalência de depressão é 2-3 vezes mais frequentem mulheres (Weissman, Bland e Canino, 1996). Nestestudo, a maioria da populacão era do gênero feminino,presentava idade superior a 48 anos e uma das condicõeslínicas mais prevalentes foram as psiquiátricas (33,9%),epresentadas especialmente por ansiedade e depressão.

Andrade et al. (2012), em estudo de transtornos mentaism grandes cidades, a partir de uma amostra representativae 5.037 adultos, verificaram que o transtorno mais comumoi a ansiedade afetando 19,9% da amostra.

Em estudo multicêntrico brasileiro sobre transtornosentais na atencão primária, Goncalves et al. (2014) encon-

raram uma prevalência de depressão entre 21,4-31% nasiferentes capitais.

Silva, Brito, Chein, Brito e Navarro (2008), avaliando
ulheres climatéricas em ambulatório do Maranhão, encon-
raram alta prevalência de depressão (34,5%). Já Nievas,uregato, Iannetta e Santos (2006), avaliando 30 mulhe-es atendidas em ambulatório, também utilizando o BDI,

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dentificaram sintomas depressivos aumentados na faixatária dos 40-49 anos.

As condicões endócrinas e metabólicas tendo como prin-ipal doenca o hipotireioidismo estiveram presentes em7,5% dos avaliados. Embora os estudos sejam controversos

com pequeno número de participantes, há concordânciae que pequenas mudancas dos níveis de hormônios tire-idianos em pacientes com depressão apresentam efeitosignificativos no funcionamento cerebral, e 15% ou maisos pacientes deprimidos apresentam insuficiência tireoidi-na mínima, sem a presenca de hipotireoidismo sistêmicoBahls e Carvalho, 2004). Pequenas alteracões na tireoidehipotireoidismo subclínico) frequentemente se associam

depressão (Romaldini, Sgarbi e Farah, 2004). Por outroado, nesta faixa etária, e com maioria de gênero feminino,e espera uma maior prevalência de tireopatia (Bensenor,lmos e Lotufo, 2012).

As pessoas relataram, em média, bons níveis de bem-estar subjetivo (BES) apesar das questões de saúdeevantadas. O conceito de BES é complexo e contempla,egundo Siqueira e Padovam (2008), 2 perspectivas em psi-ologia: a que se baseia nos estados emocionais, emocões,fetos e sentimentos e outra, que se apoia na cognicão e nasvaliacões de satisfacão com a vida em geral. O BES abarcainda o bem-estar psicológico, que, por sua vez, contempla:utoaceitacão, relacionamento positivo com outras pes-oas, autonomia, domínio do ambiente, propósito de vida

crescimento pessoal (Ryff e Keyes, 1995), além do bem-estar no trabalho. Desta forma, a avaliacão isolada destascala poderia trazer conclusões equivocadas a respeitoo bem-estar relatado pelos participantes; preferindo-se,ntão, buscar correlacão com as demais escalas utilizadas.

A atentividade, avaliada de acordo com a MAAS, foi, emédia, considerada baixa, levando-se em consideracão oonto de corte 4,22, a partir de amostra de adultos ame-icanos (Brown e Ryan, 2008).

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Observou-se correlacão inversa entre o bem-estar sub-jetivo e o BDI; resultado esperado, uma vez que estardeprimido compromete o bem-estar.

Pelo padrão da populacão que compôs este instrumento,80% declarou não ter problemas em nenhuma das dimensõesestudadas, com excecão das mulheres, sendo que dentreaqueles que apontaram problemas de saúde, à semelhancadeste estudo, porém em menor frequência, dor/mal-estar,seguido de ansiedade e depressão foram os mais relatadoscom 25,4 e 15%, respectivamente (Ministerio de Sanidad,2014).

A partir da análise SWOT, no que se refere a fraquezase fragilidades, para o item não preenchimento ou preenchi-mento incompleto de questionários, a acão proposta seráa utilizacão de plataforma própria, para preenchimentoonline, impedindo que se avance para a questão seguintese todos os campos não estiverem preenchidos.

A mudanca física do ambulatório para outra região comdiversas opcões de transporte público, além de grandedemanda de atencão primária em saúde, poderá aumentaro número de pessoas que procuram o servico.

Consideracões finais

Neste grupo prevaleceram usuários do gênero feminino,adultos, com plano de saúde e acompanhamento clínicoregular.

SUBI e BDI apresentaram forte correlacão negativa entresi. Entre a qualidade de vida e o bem-estar subjetivo foramencontradas correlacões positivas e correlacões negativasentre a qualidade de vida e os escores de depressão. Nãoforam encontradas correlacões entre qualidade de vida eestados de mindfulness.

O número reduzido de participantes do estudo foi umagrande limitacão para apresentacão dos dados. Muitosquestionários foram preenchidos de forma incorreta ouincompleta, pois eram preenchidos à mão, o que impos-sibilitou a utilizacão dos mesmos no presente estudo. Emfuturo próximo todos os dados serão imputados online, oque garantirá o preenchimento completo de todos os ins-trumentos. Além disso, a populacão observada era bastanteheterogênea, o que leva a uma interpretacão mais cuidadosados dados, principalmente na correlacão entre as escalas.Planeja-se, para futuro próximo, a intervencão em mindful-ness para grupos mais homogêneos a partir de reorganizacãoda triagem, alocando as pessoas de acordo com seu perfil desaúde e psicológico, além do motivo da procura pelo servico.

Conflito de interesses

Os autores declaram não haver conflito de interesses.

Referências

Andrade, L.H., Wang, Y., Andreoni, S., Magalha, C., Alexandrino--Silva, C., Siu, E.R., . . . Viana, M.C. (2012). o Mental Disorders inMegacities: Findings from the São Paulo Megacity Mental Health
Survey, Brazil, 7(2). http://doi.org/10.1371/journal.pone.0031879
Bahls, S., & de Carvalho, G. A. (2004). A relacão entre a funcãotireoidiana e a depressão: uma revisão. The relation between

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thyroid function and depression: A review. Rev Bras Psiquiatr.,26(1), 41---49.

arros, V. V. de, Kozasa, E. H., Cristina, I., Souza, W. De, & Ron-zani, T. M. (2015). Validity Evidence of the Brazilian Versionof the Mindful Attention Awareness Scale (MAAS). Psicolo-gia Reflexão E Crítica, 28(1), 87---95. http://dx.doi.org/10.1590/1678-7153.201528110

eck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J.(1961). An inventory for measuring depression. Arch Gen Psychi-atry., 4, 561---571.

ensenor, I. M., Olmos, R. D., & Lotufo, P. A. (2012). Hypothyroidismin the elderly: Diagnosis and management. Clin Interv Aging., 7,97---111.

rown, K. W., & Ryan, R. M. (2003). The benefits of beingpresent: Mindfulness and its role in psychological well-being. J Pers Soc Psychol, 84(4), 822---848. http://dx.doi.org/10.1037/0022-3514.84.4.822

unha, J. A. (2001). Manual da versão em português das EscalasBeck. São Paulo: Casa do Psicólogo.

e Carvalho, A. I. (2008). Princípios e prática da promocão da saúdeno Brasil. Cad Saúde Pública, 24(1), 4---5. http://dx.doi.org/10.1590/S0102-311X2008000100001

arvalho, S. R., & Gastaldo, D. (2008). Promocão à saúde e empo-deramento: uma reflexão a partir das perspectivas crítico-socialpós-estruturalista. Ciência & Saúde Coletiva, 13, 2029---2040.http://dx.doi.org/10.1590/S1413-81232008000900007

hadwick, P., Hember, M., Symes, J., Peters, E., Kuipers, E., & Dag-nan, D. (2008). Responding mindfully to unpleasant thoughts andimages: Reliability and validity of the Southampton mindfulnessquestionnaire (SMQ). [Comparative Study]. Br J Clin Psychol.,47(4), 451---455.

emarzo, M. M. P. (2012). On the Occasion of the World Men-tal Health Day Minding the Gap in Mental Health: The HealthPromotion-Primary Care-based Solution. Int J Prev Med., 3(10),670---671. Oct.

emarzo, M. M. P. (2015). Mindfulness e Promocão da Saúde. RESC.,2(3), e82.

emarzo, M. M. P. (2011). (6th ed., pp. 1---18). Meditacão aplicadaà saúde. Programa Atualizacão em Med Família e Comunidade(6) Porto Alegre-RS: Artmed., 1.

eldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J.-P.(2007). Mindfulness and emotion regulation: The developmentand initial validation of the cognitive and affective mindful-ness scalerevised (cams-r). J Psychopathol Behav Assess, 29(3),177---190.

erreira, P. L., Ferreira, L. N., & Pereira, L. N. (2013). Contributospara a Validacão da Versão Portuguesa do EQ-5D. Acta Med Port.,26(6), 664---675. Nov-Dec.

igueiredo, W. (2005). Assistência à saúde dos homens: um desa-fio para os servicos de atencão primária. Ciência & SaúdeColetiva, 10(1), 105---109. http://dx.doi.org/10.1590/S1413-81232005000100017

ortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., & Rakel,D. (2013). Abbreviated mindfulness intervention for job satisfac-tion, quality of life, and compassion in primary care clinicians:A pilot study.[Clinical Trial].

omes, R., Nascimento, E. F. do, & Araújo, F. C. de. (2007). Porque os homens buscam menos os servicos de saúde do que asmulheres? As explicacões de homens com baixa escolaridade ehomens com ensino superior Why do men use health servicesless than women? Explanations by men with low versus highereducation. Cad Saúde Pública, 23(3), 565---574.

oncalves, D. A., Mari, J. de J., Bower, P., Gask, L., Dowrick, C.,Tófoli, L. F., et al. (2014). Brazilian multicentre study of commonmental disorders in primary care: Rates and related social and
demographic factors. Cad Saude Publica., 30(3), 623---632.
otink, R. A., Chu, P., Busschbach, J. J., Benson, H., Fricchione,G. L., & Hunink, M. G. (2015). Standardised mindfulness-based

http://doi.org/10.1371/journal.pone.0031879

http://doi.org/10.1371/journal.pone.0031879








































dx.doi.org/10.1590/1678-7153.201528110

dx.doi.org/10.1590/1678-7153.201528110





































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1

H

K

K

K

L

M

N

N

R

R

S

D

S

S

T

00

interventions in healthcare: An overview of systematic revi-ews and meta-analyses of RCTs. [Research Support, Non-U.S.Gov’t]. PLoS One., 10(4), e0124344. http://dx.doi.org/10.1371/journal.pone.0124344

owells, F. M., Ives-Deliperi, V. L., Horn, N. R., & Stein, D. J.(2012). Mindfulness based cognitive therapy improves frontalcontrol in bipolar disorder: A pilot EEG study. BMC Psychiatry.,http://dx.doi.org/10.1186/1471-244X-12-15

abat-Zinn, J. (1982). An outpatient program in behavioral medi-cine for chronic pain patients based on the practice ofmindfulness meditation: Theoretical considerations and preli-minary results. Gen Hosp Psychiatry., 4(1), 33---47.

eng, S., Smoski, M. J., & Robins, C. J. (2011). Effects of mindful-ness on psychological health: A review of empirical studies. ClinPsychol Rev., 31, 1041---1056.

houry, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bou-chard, V., Hofmann, S.G. (2013). Mindfulness-based therapy: Acomprehensive meta-analysis.[Meta-Analysis].

udwig, D. S., & Kabat-Zinn, J. (2008). Mindfulness in Medicine.JAMA., 300(11), 1350---1352.

inisterio de Sanidad, Servicios Sociales e Igualdad EncuestaNacional de Salud. (2014). Espana 2011/12. Calidad de vidarelacionada con la salud en adultos: EQ-5D-5L. Serie Informesmonográficos n◦ 3. Madrid: Ministerio de Sanidad, Servicios Soci-ales e Igualdad.

agpal, R., & Sell, H. (1985). Subjective well-being. SEARO Regional
Health Papers 7. New Delhi Regional Office for South-East Asia,World Health Organization.
ievas, A. F., Furegato, a. R. F., Iannetta, O., & Santos, J. L. F.(2006). Depressão no climatério: Indicadores biopsicossociais.

W

V.L. Salvo et al.

J Bras Psiquiatr, 55(4), 274---279. http://dx.doi.org/10.1590/S0047-20852006000400003

omaldini, J. H., Sgarbi, J. A., & Farah, C. S. (2004). Disfuncõesmínimas da tiróide: hipotiroidismo subclínico e hipertiroidismosubclínico. Arq Bras Endocrinol Metab, 48(1), 147---158.

yff, C. D., & Keyes, C. L. M. (1995). The structure of psychologicalwell being revisited. J Pers Soc Psychol, 69, 719---727.

antiago, A., & Holanda, A. F. (2013). Fenomenologia da Depres-são: uma Análise da Producão Acadêmica Brasileira. Revista daAbordagem Gestáltica, 1, 38---50.

a Silva, M. C. S., & Lautert, L. (2010). O senso de auto-eficáciana manutencão de comportamentos promotores de Saúde deidosos. Rev Esc Enferm USP., 44(1), 61---67.

ilva, M. M., Maria, L., Brito, O., Bethânia, M., Brito, G. O., Andréa,P., & Salles, D. A. (2008). Depressão em mulheres climatéri-cas: análise de mulheres atendidas ambulatorialmente em umhospital universitário no Maranhão. Rev Psiquiatr RS, 30(2),150---154.

iqueira, M. M. M., & Padovam, V. A. R. (2008). BasesTeóricas de Bem-Estar Subjetivo, Bem estar psicológico eBem-Estar no Trabalho. Psicologia: Teoria e Pesquisa, 24(2),201---209.

ravassos, P. F. da S., & Vieira, F. de O. (2011). Aplicacão da aná-lise SWOT, na preparacão do processo de avaliacão institucionalinterna (Auto-Avaliacão) realizada pela IES. Revista Eletronicade Administracão, 10(2), 1---14.

eissman, M. M., Bland, R. C., Canino, G. J., Faravelli, C.,Greenwald, S., Hwu, H. G., et al. (1996). Cross-national epide-miologic of major depression and bipolar disorder. JAMA., 276,293---299.

dx.doi.org/10.1371/journal.pone.0124344

dx.doi.org/10.1371/journal.pone.0124344

dx.doi.org/10.1186/1471-244X-12-15



























































































































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GUIDE FOR AUTHORS www.elsevier.com

Mindfulness & Compassion (M&C) is the offi cial journal of the Master of Mindfulness at the University of Zaragoza (Spain). M&C is published in electronic and printed format and its frequency is biannual (ISSN: 2445-4079). The journal was launched in 2016 and publishes original theoretical, methodological and empirical research dealing with questions that are relevant to mindfulness & compassion clinicians and researchers.

The editorial process. The Editorial board is composed of senior scientists with local roots to facilitate in-person meet-ings and follow revision processes closely. Editors asses in fi rst place the potential value added of the paper as a function of the problem statement, proper methodology and relevant implications. Papers that do not fall within the scope of the Journal or that do not to reach a minimum threshold are returned to the authors (desk-rejected), usually within three to fi ve days. Papers that are considered suitable for revision are reviewed using a ‘double blind’ process. Referees are asked to read the article and try to fi gure out if anybody else would. If the answer is yes, we ask them to tell us who will be in-terested in the results and why, highlight any technical fl aws that could compromise the authors’ contribution, and make suggestions that should be basically editorial in nature. This feedback will be thoughtfully considered by the Editors before sending their decision to the corresponding author. The judgment about which changes are needed and, ultimately, which papers will interest M&C’s broad readership is made by our editors; not by our referees. The Editors’ goal is to minimize rounds and increase speed while guaranteeing a rigorous contribution that our subscribers read. Papers accepted by M&C will be published in ahead of print section, which provides immediate access and doi citation to fi nalized manuscripts prior to its assignment to an issue.

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There are several cornerstones in the pursuit of ethical excellence. The publisher of M&C, for instance, offers a website with tools and resources that allow authors to proceed confi dently: http://www.elsevier.com/ethics/home. This website helps authors and editors to avoid misconduct in several important issues:

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Our online submission system guides you stepwise through the process of entering your article details and uploading your fi les. The system converts your article fi les to a single PDF fi le used in the peer-review process. Editable fi les (e.g., Word, LaTeX) are required to typeset your article for fi nal publication. All correspondence, including notifi cation of the Editor’s decision and requests for revision, is sent by e-mail.

Submit your article

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Referees

Please submit the names and institutional e-mail addresses of several potential referees. For more details, visit our Support site. Note that the editor retains the sole right to decide whether or not the suggested reviewers are used.

PREPARATION

Double-blind review

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Use of word processing software

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To avoid unnecessary errors you are strongly advised to use the ‘spell-check’ and ‘grammar-check’ functions of your word processor.

Embedded math equations

If you are submitting an article prepared with Microsoft Word containing embedded math equations then please read this related support information (http://support.elsevier.com/app/answers/detail/a_id/302/).

Article structure Submission guidelines

1. Papers are expected to be submitted in English; however, authors may submit their work in Spanish as long as they translate it at their expense once the fi nal version is accepted. All manuscript considered for submission must be sent online by accessing the Elsevier Editorial System at http://ees.elsevier.com/mindcomp.

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tively numbered indicating their title and source, as well as their approximate position in the main text.9. References will be cited in text with an author-date system. Citations will be listed alphabetically at the end of the pa-

per. Please ensure that every reference cited has a corresponding citation in the text and vice versa.

Subdivision - numbered sections

Divide your article into clearly defi ned and numbered sections. Subsections should be numbered 1.1 (then 1.1.1, 1.1.2,...), 1.2, etc. (the abstract is not included in section numbering). Use this numbering also for internal cross-referencing: do not just refer to ‘the text’. Any subsection may be given a brief heading. Each heading should appear on its own separate line.

Essential title page information

• Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid abbreviations and formu-lae where possible.

• Author names and affi liations. Please clearly indicate the given name(s) and family name(s) of each author and check that all names are accurately spelled. Present the authors’ affi liation addresses (where the actual work was done) below the names. Indicate all affi liations with a lower-case superscript letter immediately after the author’s name and in front of the appropriate address. Provide the full postal address of each affi liation, including the country name and, if available, the e-mail address of each author.

• Corresponding author. Clearly indicate who will handle correspondence at all stages of refereeing and publication, also post-publication. Ensure that the e-mail address is given and that contact details are kept up to date by the corresponding author.

• Present/permanent address. If an author has moved since the work described in the article was done, or was vis-iting at the time, a ‘Present address’ (or ‘Permanent address’) may be indicated as a footnote to that author’s name. The address at which the author actually did the work must be retained as the main, affi liation address. Superscript Arabic numerals are used for such footnotes.

Keywords

Immediately after the abstract, provide a maximum of 6 keywords, using American spelling and avoiding general and plu-ral terms and multiple concepts (avoid, for example, ‘and’, ‘of’). Be sparing with abbreviations: only abbreviations fi rmly established in the fi eld may be eligible. These keywords will be used for indexing purposes.

Abbreviations

Defi ne abbreviations that are not standard in this fi eld in a footnote to be placed on the fi rst page of the article. Such abbreviations that are unavoidable in the abstract must be defi ned at their fi rst mention there, as well as in the footnote. Ensure consistency of abbreviations throughout the article.


Acknowledgements

Collate acknowledgements in a separate section at the end of the article before the references and do not, therefore, in-clude them on the title page, as a footnote to the title or otherwise. List here those individuals who provided help during the research (e.g., providing language help, writing assistance or proof reading the article, etc.).

Math formulae

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Footnotes

Footnotes should be used sparingly. Number them consecutively throughout the article. Many word processors can build footnotes into the text, and this feature may be used. Otherwise, please indicate the position of footnotes in the text and list the footnotes themselves separately at the end of the article. Do not include footnotes in the Reference list.

Artwork

Electronic artwork General points

• Make sure you use uniform lettering and sizing of your original artwork. • Embed the used fonts if the application provides that option. • Aim to use the following fonts in your illustrations: Arial, Courier, Times New Roman, Symbol, or use fonts that look

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A detailed guide on electronic artwork is available on our website: http://www.elsevier.com/artworkinstructions.

You are urged to visit this site; some excerpts from the detailed information are given here.

Formats

If your electronic artwork is created in a Microsoft Offi ce application (Word, PowerPoint, Excel) then please supply ‘as is’ in the native document format.

Regardless of the application used other than Microsoft Offi ce, when your electronic artwork is fi nalized, please ‘Save as’ or convert the images to one of the following formats (note the resolution requirements for line drawings, halftones, and line/halftone combinations given below):

• EPS (or PDF): Vector drawings, embed all used fonts.• TIFF (or JPEG): Color or grayscale photographs (halftones), keep to a minimum of 300 dpi.• TIFF (or JPEG): Bitmapped (pure black & white pixels) line drawings, keep to a minimum of 1000 dpi. TIFF (or JPEG):

Combinations bitmapped line/half-tone (color or grayscale), keep to a minimum of 500 dpi.

Please do not:

• Supply fi les that are optimized for screen use (e.g., GIF, BMP, PICT, WPG); these typically have a low number of pixels and limited set of colors;

• Supply fi les that are too low in resolution; • Submit graphics that are disproportionately large for the content.

Color artwork

Please make sure that artwork fi les are in an acceptable format (TIFF (or JPEG), EPS (or PDF), or MS Offi ce fi les) and with the correct resolution. If, together with your accepted article, you submit usable color fi gures then Elsevier will ensure, at no additional charge, that these fi gures will appear in color online (e.g., ScienceDirect and other sites) regardless of whether or not these illustrations are reproduced in color in the printed version. For color reproduction in print, you will receive information regarding the costs from Elsevier after receipt of your accepted article. Please indicate


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Please note: Because of technical complications that can arise by converting color fi gures to ‘gray scale’ (for the printed ver-sion should you not opt for color in print) please submit in addition usable black and white versions of all the color illustrations.

Illustration services

Elsevier’s WebShop (http://webshop.elsevier.com/illustrationservices) offers Illustration Services to authors preparing to submit a manuscript but concerned about the quality of the images accompanying their article. Elsevier’s expert illustra-tors can produce scientifi c, technical and medical-style images, as well as a full range of charts, tables and graphs. Image ‘polishing’ is also available, where our illustrators take your image(s) and improve them to a professional standard. Please visit the website to fi nd out more.

Figure captions

Ensure that each illustration has a caption. Supply captions separately, not attached to the fi gure. A caption should com-prise a brief title (not on the fi gure itself) and a description of the illustration. Keep text in the illustrations themselves to a minimum but explain all symbols and abbreviations used.

Tables

Please submit tables as editable text and not as images. Tables can be placed either next to the relevant text in the arti-cle, or on separate page(s) at the end. Number tables consecutively in accordance with their appearance in the text and place any table notes below the table body. Be sparing in the use of tables and ensure that the data presented in them do not duplicate results described elsewhere in the article. Please avoid using vertical rules.

References

References should be prepared using the Publication Manual of the American Psychological Association for style. They should be placed on a separate sheet at the end of the paper, double-spaced, in alphabetical order.

References should be quoted in the text by giving the author’s name, followed by the year, e.g. (Hubbard & Ramachan-dran, 2001) or Hubbard and Ramachandran (2001).

For more than two authors, all names are given when fi rst cited, but when subsequently referred to, the name of the fi rst author is given followed by the words et al., as for example--First citation: Reuter, Roth, Holve and Hennig (2006) but subsequently, Reuter et al. (2006).

References to journals should include the author’s name followed by initials, year, paper title, journal title, volume num-ber and page numbers, e.g. Nettle, D. (2006). Schizotypy and mental health amongst poets, visual artists, and mathema-ticians. Journal of Research in Personality, 40, 876-890.

References to books should include the author’s name followed by initials, year, paper title, editors, book title, volume and page numbers, place of publication, publisher, e.g. Fitzgerald, M. (2004). Autism and creativity: Is there a link between autism in men and exceptional ability? Hove and New York: Brunner-Routledge.

Or

Thompson, J. (2006). The Mad, the ′Brut′, the ′Primitive′ and the Modern. A discursive history. In F. Andrada, E. Martin, & A. Spira (Eds.), Inner worlds outside (pp. 51-69). Dublin: Irish Museum of Modern Art.

Citation in text

Please ensure that every reference cited in the text is also present in the reference list (and vice versa). Any references cited in the abstract must be given in full. Unpublished results and personal communications are not recommended in the reference list, but may be mentioned in the text. If these references are included in the reference list they should follow the standard reference style of the journal and should include a substitution of the publication date with either ‘Unpub-lished results’ or ‘Personal communication’. Citation of a reference as ‘in press’ implies that the item has been accepted for publication.

Reference links

Increased discoverability of research and high quality peer review are ensured by online links to the sources cited. In or-der to allow us to create links to abstracting and indexing services, such as Scopus, CrossRef and PubMed, please ensure


that data provided in the references are correct. Please note that incorrect surnames, journal/book titles, publication year and pagination may prevent link creation. When copying references, please be careful as they may already contain errors. Use of the DOI is encouraged.

Web references

As a minimum, the full URL should be given and the date when the reference was last accessed. Any further information, if known (DOI, author names, dates, reference to a source publication, etc.), should also be given. Web references can be listed separately (e.g., after the reference list) under a different heading if desired, or can be included in the reference list.

References in a special issue

Please ensure that the words ‘this issue’ are added to any references in the list (and any citations in the text) to other ar-ticles in the same Special Issue.

Reference management software

Most Elsevier journals have a standard template available in key reference management packages. This covers pack-ages using the Citation Style Language, such as Mendeley (http://www.mendeley.com/features/reference-manager) and also others like EndNote (http://www.endnote.com/support/enstyles.asp) and Reference Manager (http://refman.com/downloads/styles). Using plug-ins to word processing packages which are available from the above sites, authors only need to select the appropriate journal template when preparing their article and the list of references and citations to these will be formatted according to the journal style as described in this Guide. The process of including templates in these packages is constantly ongoing. If the journal you are looking for does not have a template available yet, please see the list of sample references and citations provided in this Guide to help you format these according to the journal style.

If you manage your research with Mendeley Desktop, you can easily install the reference style for this journal.

When preparing your manuscript, you will then be able to select this style using the Mendeley plugins for Microsoft Word or LibreOffi ce. For more information about the Citation Style Language, visit http://citationstyles.org.

Reference Style

References will be cited in text with an author-date system. Citations will be listed alphabetically at the end of the paper. Please ensure that every reference cited has a corresponding citation in the text and vice versa.

Video data

Elsevier accepts video material and animation sequences to support and enhance your scientifi c research. Authors who have video or animation fi les that they wish to submit with their article are strongly encouraged to include links to these within the body of the article. This can be done in the same way as a fi gure or table by referring to the video or anima-tion content and noting in the body text where it should be placed. All submitted fi les should be properly labeled so that they directly relate to the video fi le’s content. In order to ensure that your video or animation material is directly usable, please provide the fi les in one of our recommended fi le formats with a preferred maximum size of 150 MB. Video and an-imation fi les supplied will be published online in the electronic version of your article in Elsevier Web products, including ScienceDirect: http://www.sciencedirect.com. Please supply ‘stills’ with your fi les: you can choose any frame from the video or animation or make a separate image. These will be used instead of standard icons and will personalize the link to your video data. For more detailed instructions please visit our video instruction pages at http://www.elsevier.com/artworkinstructions. Note: since video and animation cannot be embedded in the print version of the journal, please provide text for both the elec-tronic and the print version for the portions of the article that refer to this content.

Supplementary material

Elsevier accepts electronic supplementary material to support and enhance your scientifi c research. Supplementary fi les offer the author additional possibilities to publish supporting applications, high-resolution images, background datasets, sound clips and more. Supplementary fi les supplied will be published online alongside the electronic version of your article in Elsevier Web products, including ScienceDirect: http://www.sciencedirect.com. In order to ensure that your submitted material is directly usable, please provide the data in one of our recommended fi le formats. Authors should submit the material in electronic format together with the article and supply a concise and descriptive caption for each fi le. For more detailed instructions please visit our artwork instruction pages at http://www.elsevier.com/artworkinstructions.

Submission checklist

The following list will be useful during the fi nal checking of an article prior to sending it to the journal for review. Please consult this Guide for Authors for further details of any item.


Ensure that the following items are present:

One author has been designated as the corresponding author with contact details:

• E-mail address • Full postal address

All necessary fi les have been uploaded, and contain:

• Keywords • All fi gure captions • All tables (including title, description, footnotes)

Further considerations:

• Manuscript has been ‘spell-checked’ and ‘grammar-checked’ • References are in the correct format for this journal • All references mentioned in the Reference list are cited in the text, and vice versa • Permission has been obtained for use of copyr ighted material from other sources (including the Internet)

Printed version of fi gures (if applicable) in color or black-and-white:

• Indicate clearly whether or not color or black-and-white in print is required• For reproduction in black-and-white, please supply black-and-white versions of the fi gures for printing purposes

For any further information please visit our customer support site at http://support.elsevier.com.

AFTER ACCEPTANCE

Use of the Digital Object Identifi er

The Digital Object Identifi er (DOI) may be used to cite and link to electronic documents. The DOI consists of a unique alpha-numeric character string which is assigned to a document by the publisher upon the initial electronic publication. The assigned DOI never changes. Therefore, it is an ideal medium for citing a document, particularly ‘Articles in press’ because they have not yet received their full bibliographic information. Example of a correctly given DOI (in URL format; here an article in the journal Physics Letters B):

http://dx.doi.org/10.1016/j.physletb.2010.09.059

When you use a DOI to create links to documents on the web, the DOIs are guaranteed never to change.

Proofs

One set of page proofs (as PDF fi les) will be sent by e-mail to the corresponding author (if we do not have an e-mail ad-dress then paper proofs will be sent by post) or, a link will be provided in the e-mail so that authors can download the fi les themselves. Elsevier now provides authors with PDF proofs which can be annotated; for this you will need to down-load Adobe Reader version 9 (or higher) available free from http://get.adobe.com/reader. Instructions on how to anno-tate PDF fi les will accompany the proofs (also given online). The exact system requirements are given at the Adobe site: http://www.adobe.com/products/reader/tech-specs.html.

If you do not wish to use the PDF annotations function, you may list the corrections (including replies to the Query Form) and return them to Elsevier in an e-mail. Please list your corrections quoting line number. If, for any reason, this is not possible, then mark the corrections and any other comments (including replies to the Query Form) on a printout of your proof and return by fax, or scan the pages and e-mail, or by post. Please use this proof only for checking the typeset-ting, editing, completeness and correctness of the text, tables and fi gures. Signifi cant changes to the article as accepted for publication will only be considered at this stage with permission from the Editor. We will do everything possible to get your article published quickly and accurately. It is important to ensure that all corrections are sent back to us in one communication: please check carefully before replying, as inclusion of any subsequent corrections cannot be guaranteed. Proofreading is solely your responsibility.

AUTHOR INQUIRIES

You can track your submitted article at http://www.elsevier.com/track-submission. You can track your accepted article at http://www.elsevier.com/trackarticle. You are also welcome to contact Customer Support via http://support.elsevier.com.

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