Mindfulness, which has been linked to various health benefits, is a method that teaches individuals how to regulate attention while applying non-judgmental acceptance, whereas the existential approach supports the uniqueness of each individual and helps with finding meaning in one’s life. Meta-analyses showed that mindfulness-based interventions (MBI) are moderately effective in reducing stress, depression, anxiety and distress and in ameliorating the quality of life of healthy individuals , and that MBI may help to improve psychological functioning in employees . There is preliminary but insufficient evidence for self-compassion and psychological flexibility as mechanisms underlying mindfulness-based interventions .
Recently, we performed a randomized controlled trial to examine whether MBI and the existential approach could be combined sequentially, as well as whether they would operate antagonistically or cooperatively . In that study, apparently healthy participants were first allocated to a waiting-list group, then subsequently assigned randomly to either 8-week MBI group or 4-week MBI group followed by 4-week existential approach (EXMIND) group.
With regard to how to perform EXMIND, the EXMIND consisted of weekly MBI for 4 weeks plus subsequent weekly existential approach for 4 weeks. The maximum number of participants per session was up to 23. It took 90–120 min for participants to complete each session. Just before each session, 30 min was allocated for them to fill out the questionnaires. No payment was required from participants.
During the first half (4 weeks), MBI sessions included raisin exercise, mindful breathing, body scan, walking meditation, and sitting meditation. Participants received explanatory notes at every session. Homework including both formal and informal training was encouraged for participants to train themselves for mindfulness reskilling.
During the second half (4 weeks), the EXMIND group started life-scan where participants observed their life from the past, present, and future. This method was based on Orbanic’s description of “The therapist assists distraught individuals in discovering meaningfulness, finding purpose, and actualizing self-love by facilitating deeper self-awareness, appreciation, and understanding of who they are, have been and their unique process of becoming. The therapist, guided by this view, helps a hopeless individual realize that as a ‘person being-in-time’, he or she is always living in limitless temporality where change is inevitable, and the future bestows hope”, which was based on Heidegger’s philosophy. In order to do so, we performed a life-scan where each individual was instructed to recall past successful (reasonable) experiences and their success was commended by actual working members, which probably brought about meaningfulness and pleasure of achieving purpose. Also, each individual was asked to recall past miserable (unreasonable) experiences, and their patience and perseverance were respected by the actual working members, which probably actualized self-love (or self-esteem). Moreover, thinking about the purpose and meaning of life not attributed to common sense but to their individual proper thought during individual interviews was considered to be the very existential, and considering that death awareness and contemplating it allows one to prioritize and decide what is important to a meaningful and creative experience for each individual life, confirming individual will to live better in the uncertain future during individual interviews was likely to be the very existential. Following the above notions, they continued to perform mindfulness as homework where they could include life-scan; at session 5, recalling past successful (reasonable) experiences and their success was commended during individual interviews; at session 6, recalling past miserable (unreasonable) experiences, and their patience and perseverance were respected during individual interviews; at session 7, thinking about the purpose and meaning of life not attributed to common sense but to their proper thought, accepting themselves as they are, and understanding that they are happy when they think so during individual interviews; at session 8, confirming individual will to live better in the uncertain future during individual interviews.
The primary outcome was Self-Compassion Scale (SCS) total scores taken at the beginning of the study (baseline), then at 4 weeks and 8 weeks, either during the intervention or while waiting. When viewing the results, both 8-week MBI and EXMIND groups showed a significant increase in SCS total scores, as compared to those in the waiting group, suggesting that MBI and an existential approach are not antagonistic, but may have cooperative effects. Furthermore, these results suggest that EXMIND may be a useful treatment.
As afore-mentioned in the previous paper , we had thought that MBI has static or passive components such as attentional control and non-judgmental acceptance, whereas the existential approach has dynamic or active components such as discovering meaningfulness, finding purpose, and actualizing self-esteem. In other words, it seems likely that MBI tries to accept the world as it is whereas existential approach attempts changing the world within each individual. Therefore, in our opinion, these two therapies may have opposite components and it is unclear whether combining MBI and existential approach sequentially would cause antagonistic effects or whether they operate in a cooperative manner.
Although the results were not antagonistic in the EXMIND as a whole , at the individual level, we confirmed that there were four different response patterns during the EXMIND (i.e., 4-week mindfulness-based intervention (MBI) followed by 4-week existential approach) by subtracting total Self-Compassion Scale scores at baseline from those at 4 weeks, and subtracting those at 4 weeks from those at 8 weeks individually: participants who responded positively to MBI, but negatively to the existential approach; participants who responded negatively to MBI, but positively to the existential approach; participants who responded positively to both MBI and the existential approach; and participants who responded negatively to both MBI and the existential approach. These were simple categorization of which threshold was 0 (0 or less than 0 were negative responses whereas more than 0 were positive responses).
With regard to predictors to MBI and/or EXMIND, high educational attainment predicted a decrease in depressive symptoms by MBI . Although MBI was associated with significant increases in trait positive affect and momentary positive cognition , in a systematic review, two found no association between mindfulness interventions and cognitive function, two found improvement that was not sustained at the follow-up, and another two found sustained improvement at 2- or 6-months . Besides intelligence, the quality of family relationships could affect mindfulness . As for purpose in life (or life’s meaning), patients’ search for life’s meaning was the only significant predictor of willingness to participate in MBSR in cancer patients . Also, cancer patients endorsing higher levels of dispositional mindfulness were more likely to pay attention to positive experiences, a tendency which was associated with positive reappraisal of stressful life events. Moreover, patients who engaged in more frequent positive reappraisal had a greater sense of meaning in life . Regrettably, we could not find reports showing predictors to existential approach.
This study aims to identify the predictors of response patterns to EXMIND (weekly MBI for 4 weeks plus subsequent weekly existential approach for 4 weeks).