Use of Mindful Reappraisal Coping Among Meditation Practitioners

Adam Hanley,1 Eric L. Garland,2 and David S. Black3

1Florida State University2University of Utah3University of California

Objective: By enhancing positive affect and cognitive flexibility, mindfulness practice may promotereappraisal of stressors. We hypothesized that coping through mindful reappraisal would be commonamong mindfulness practitioners from an array of traditions. Method: A sample of 118 meditationpractitioners completed an online survey comprising assessments of the prevalence and frequencyof mindful reappraisal, as well as measures of well-being and distress. Results: Regular use ofmindful reappraisal was reported by over half of the sample and was significantly correlated with yearsof meditation practice (r = .31, p = .01), meditation practice days per month (r = .30, p = .001),and meditation hours per week (r = .30, p = .001). Controlling for frequency of meditation practiceand trait mindfulness, mindful reappraisal frequency explained significant portions of variance in well-being (P <.001) and distress (P <.001). Conclusions: Meditation practitioners commonly employmindful reappraisal coping as a positive emotion regulatory strategy in stressful contexts. C© 2013Wiley Periodicals, Inc. J. Clin. Psychol. 00:1–8, 2013.

Mindfulness training and its mechanisms of action have been the focus of considerable empiricaland theoretical exploration in recent years (Chamber, Gullone, & Allen, 2009; Garland, Gaylord,& Frerickson, 2011; Farb, Anderson, & Segal, 2012; Holzel et al., 2011; Shapiro, Carlson,Astin, & Freedman, 2006). As mindfulness can refer to a state of awareness, psychologicaltrait, or practice (Garland et al., 2010), operationalization has proven to be a complex task,complicating research and discourse. State mindfulness is a naturalistic mindset characterizedby an attentive and nonjudgmental metacognitive monitoring of moment-by-moment cognition,emotion, perception, and sensation without fixation on thoughts of past and future (Garland,2007; Lutz, Slagter, Dunne, & Davidson, 2008). Trait mindfulness is defined as the propensity toexhibit this nonjudgmental awareness of present-moment experience in everyday life (Baer et al.,2006). Mindfulness practice is designed to evoke and foster the state and trait of mindfulness. Thepractice of mindfulness involves repeated placement of attention onto an object while alternatelyacknowledging and letting go of distracting thoughts and emotions (Lutz et al., 2008). Overtime, the trait of mindfulness may be developed through repeated practice of engaging the stateof mindfulness (Carmody & Baer, 2008).

Enhanced mindfulness is one mechanism linking mindfulness practice to health-related out-comes. Studies show that mindfulness (as a state, trait, and practice) is associated with improve-ments in well-being (Carmody & Baer, 2008), rumination (Deyo, Wilson, Ong, & Koopman,2009), depression symptoms (Black, Sussman, Johnson, & Milam, 2012a; Hoffman, Grossman,& Hinton, 2010), anxiety (Hoffman et al., 2010), and psychological stress (Black, Sussman,Johnson, & Milam, 2012a; Carmody & Baer, 2008). However, other possible mechanisms ofaction have been proposed as therapeutic mechanisms of mindfulness, including metacognitiveawareness (Teasdale, Segal, & Williams, 1999), decentering (Segal, Williams, & Teasdale, 2002),cognitive defusion (Masuda, Hayes, Sackett, & Twohig, 2004), acceptance (Brown & Ryan,2004), insight (Grabovac, Lau, & Willett, 2011), detachment (Bohart, 1983), and reperceiving

This project was supported by grants from the National Institute on Drug Abuse (DA032517 to E.L.G.)and the National Cancer Institute (T32 CA09492 to D.S.B.)

Please address correspondence to: Eric L. Garland, College of Social Work, 395 South, 1500 East, Salt LakeCity, UT 84112. E-mail: egarland@fsu.edu

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 00(00), 1–8 (2013) C© 2013 Wiley Periodicals, Inc.Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22023

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(Shapiro et al., 2006). While these constructs differ, all are presumed to represent processes thatare nonevaluative and nondiscursive in nature.

The nonelaborative, nondiscursive nature of mindfulness is central to many East Asian con-templative traditions (e.g., Zen) and is held as fundamental to some recent psychological concep-tualizations of mindfulness (Grabovac et al., 2011). In contrast, the Western mind is embeddedin autobiographical narratives used to make meaning in life and negotiate the sociocultural envi-ronment (Koster, 2009; Boden & Berenbaum, 2010). Indeed, the attribution of linguistic meaningto experience is considered a critical developmental process in Western society (Vygotsky, 1978),allowing for individual integration into a shared symbolic culture (Koster, 2009). Though mind-fulness practices cultivate nondiscursive, nonevaluative states of mind, when formal mindfulnesspractice sessions end, Westerners tend to refocus on their autobiographical selves constitutedby language and personal narratives. Thus, while mindfulness meditation techniques may tem-porarily suspend evaluative language, it is inevitable that Westerners will reengage with theirnarratives. Cultivation of the nonevaluative state of mindfulness may encourage greater cogni-tive flexibility and the construction of adaptive narratives that are more consistent with personaland prosocial values (Shapiro et al., 2006). In this regard, understanding the interface betweenthe nonevaluative, experiential aspects of mindfulness practice and the cognitive narratives ofeveryday life is paramount. Moreover, the way in which mindfulness practice may promote thegeneration of meaning in the face of adversity may be clinically relevant.

Garland and colleagues (Garland, Gaylord, & Park 2009; Garland et al., 2010, 2011; Gar-land 2013) theorize that mindfulness training promotes meaning-based coping with stressful lifeevents by facilitating positive reappraisal. Positive reappraisal is defined as the active reinter-pretation of stressful events as benign, beneficial, or meaningful (Lazarus & Folkman, 1984),and is associated with a number of salutary mental health outcomes (Helgeson, Reynolds, &Tomich, 2006). As originally articulated in the Mindful Coping Model (Garland et al., 2009),mindfulness and positive reappraisal are distinct yet related components of an emotion reg-ulatory process. This “mindful reappraisal” coping process is theorized to unfold as follows.First, through the practice of mindfulness meditation, decentering from stress appraisals intothe nonevaluative state of mindfulness disrupts automatic emotional reactivity and broad-ens attention to encompass previously unattended contextual information. Specifically, decen-tering encourages awareness of cognitive and emotive processes as ephemeral mental eventswithout intrinsic veridicality, allowing practitioners to respond more flexibly to challengingcircumstances.

Next, by gaining access to a broader set of information from which new, more adaptive sit-uational appraisals may be generated, mindfulness engenders authentic, positive reappraisals,allows for flexible selection from a variety of mental scripts, and encourages productive reengage-ment with stressful life events. For example, a heart attack may initially be interpreted as a deathsentence, but later may be reappraised as the catalyst for healthy lifestyle changes and a renewedappreciation for life. Finally, insofar as positive reappraisals stimulate positive emotions, theyare theorized to expand the scope of attention while increasing cognitive flexibility (Fredrickson,2004), potentially stimulating a cognitive-emotional feedback loop, or “upward spiral” (Gar-land et al., 2010), which may enhance overall positive affectivity and trait mindfulness (Garlandet al., 2011). Therefore, positive reappraisal may expand and promote the salutary effects ofmindfulness practices by linking skills developed in mindfulness training with meaning-makingprocesses. In this sense, positive reappraisal may be seen as an adaptive byproduct of mindfulnesspractice.

This upward spiral may reciprocally energize the interaction between mindfulness and positivereappraisal, resulting in further increases in well-being. In that regard, the cultivation of self-compassion and loving-kindness in mindfulness practice may engender positive emotions byactivating brain regions involved in positive affect (e.g., left prefrontal cortex, see Davidson et al.,2003). In turn, positive emotions broaden the scope of cognition (Fredrickson & Branigan, 2005)and may tune information processing to detect stimuli that are congruent with the prevailingpositive affective state (Friedman & Forster, 2010). Thus, when mindfulness practice inducespositive feelings (e.g., contentment or joy), mindful awareness may be selectively tuned to processpositive contextual information, thus resulting in a positive reappraisal of a stressor. Ultimately,

Mindful Reappraisal Coping 3

navigating adversity through mindful reappraisal may attenuate negative emotional reactions,increase self-efficacy for emotional self-regulation, and promote well-being by establishing asense of coherence (Antonovsky, 1987) or meaning in life (Seligman, 2011).

This model of mindful reappraisal has been supported by a number of empirical investigations.A prospective observational study of over 300 adults in mindfulness-based stress and painmanagement programs revealed that the stress-reducing effects of mindfulness training werepartially mediated by increases in positive reappraisal (Garland et al., 2011). In addition, a quasi-experimental investigation found that, relative to a comparison group, participants of a mindfulcommunication class had significantly greater increases in trait mindfulness, which were coupledwith enhanced positive reappraisal (Huston, Garland, & Farb, 2011). Further, research usingelectroencephalography (EEG; Gootjes, Franken, & Van Strien, 2010) and functional magneticresonance imaging (fMRI; Modinos, Ormel, & Aleman, 2010) has revealed a neurobiologicallink between mindfulness and reappraisal. Recently, Troy, Shallcross, Davis, and Mauss (2012)found that persons who had completed mindfulness-based cognitive therapy (Segal et al., 2002)demonstrated significantly greater positive reappraisal efficacy during an experimental sadnessinduction than a matched control group or persons who had been treated with cognitive-behavioral therapy. Thus, preliminary evidence supporting the relationship between mindfulnessand positive reappraisal indicates that the capacity to positively reappraise negative situationsmay be developed through the practice of mindfulness.

Although these studies provide some evidence of a linkage between mindfulness and posi-tive reappraisal, it is still unknown whether this theoretical conceptualization is consistent withthe phenomenological experience of mindfulness practitioners. In addition, theorists have sup-posed that during mindfulness meditation, a state of mindfulness may arise in which sensoryinformation is registered without appraisal, evaluation, or interpretation (Holzel et al., 2011).Among advanced practitioners, this state of nonappraisal may be sustained throughout muchof the meditation; however, particularly among novice practitioners, this state may be relativelytransient and eventually give way to appraisal processes (Zeidan, Grant, Brown, McHaffie, &Coghill, 2012). Thus, it is commonly believed that mindful reappraisal may be more likely to beemployed by novice practitioners (Chiesa, Serretti, & Jacobsen, 2013; Holzel et al., 2011; Zeidanet al., 2012).

The purpose of the present study is to examine the extent to which practitioners from a numberof mindfulness traditions report using mindfulness to promote positive reappraisal coping, andwhether mindful reappraisal is more common among advanced or novice practitioners. Wehypothesized that, across contemplative traditions, mindfulness practitioners would endorseengaging in mindful reappraisal, and that more extensive use of mindful reappraisal would beassociated with higher levels of trait mindfulness and well-being, and lower levels of depression,anxiety, and stress. In addition, we sought to test the previously hypothesized inverse relationbetween mindful reappraisal and mindfulness meditation experience (e.g., Holzel et al., 2011;Zeidan et al., 2012).

Methods

Participants

One hundred and eighteen respondents (age mean [M] = 27.38, standard deviation [SD] = 12.78;69 female, 40 male, and 9 undisclosed) completed a voluntary and anonymous online surveyassessing mindfulness, emotion, and well-being. The announcement about the online survey wasdistributed on a meditation listserv with a reach of approximately 2,000 people. The majorityof respondents held higher education degrees: MD, PhD, or equivalent n = 40 (34%), master’sdegree n = 48 (41%), 4-year college degree n = 23 (19%), 2-year college degree n = 5 (4%),and high school n = 1 (.01%), and they were Caucasian (n = 100 (85%), other n = 10 (8%),Asian n = 5 (4%), Hispanic n = 1 (.01%), and African American n = 1 (.01%)). Respondentswere asked to identify the type of contemplative (mindfulness) practice in which they engagedand to report on the duration and frequency of their mindfulness practice. Respondents wereable to select multiple practices and were encouraged to write in any practice not included in

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the categories presented. The University of Southern California’s Institutional Review Boardapproved the study protocol.

Measures

The use of mindful reappraisal coping was assessed with three question items derived fromprior theory and empirical research on this construct (Garland et al., 2009, 2011): “How oftendoes mindfulness help you to see the positive side of difficult situations?”; “How often doesmindfulness help you to realize that you can grow stronger from difficult circumstances?”;and “How often does mindfulness help you to notice pleasant things in the face of difficultcircumstances?” Respondents used a Likert-type scale indicating how often they employedmindful reappraisal to cope with stressors and daily hassles for the period of the past 7 days.Response options ranged from 0 (never) to 4 (almost always). Higher scores indicated morefrequent use of mindful reappraisal to cope with stressors and daily hassles. These three itemswere summed to produce a mindful reappraisal frequency total score. The three items had aCronbach’s alpha of .78 with inter-item correlations ranging from .55 to .60.

The six-item Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003; Black,Sussman, Johnson & Milam, 2012b) was used to assess trait mindfulness. This measure hasdemonstrated strong psychometric properties, including high Cronbach alphas (MAAS α = .87)as well as convergent, divergent, and discriminant validity across diverse populations (Brown& Ryan, 2003; MacKillop & Anderson, 2007). Responses on the MAAS were reported on a6-point scale 1 (almost always) to 6 (almost never). Responses were reverse coded so higher scoresindicated higher trait mindfulness.

One well-being measure and one of the mental health measures were also administered.The World Health Organization Well Being Index (WHO-5; WHO, 1998) World HealthOrganization info package. (1998). Mastering depression in primary care. Frederiksborg:Regional Office for Europe Psychiatric Research Unit is a five-item subjective well-being mea-sure of quality of life in the preceding 2 weeks (International Wellbeing Group, 2006). The21-item Depression Anxiety and Stress Scale (DASS-21; Henry & Crawford, 2005) quantifiesparticipants’ experience of psychological distress in the past week.

Analysis

Descriptive statistics and coefficient analyses were generated in SPSS version 20. Two-tailedstatistical tests were used with significance criteria of p < .05. Analysis of variance was usedto determine if mindful reappraisal frequency differed by mindfulness practice type. In thisanalysis, we included practitioners from the most common contemplative traditions representedin our sample (i.e., mindfulness-based stress reduction [MBSR], Yoga, Shamatha-Vipassana,mindfulness-based cognitive therapy [MBCT], and general mindfulness meditation). Given thatthe association between mindful reappraisal coping and mental health might be confoundedby levels of trait mindfulness and frequency of mindfulness practice, multiple regression wasused to test if the frequency of mindful reappraisal significantly predicted both well-being andpsychological distress, after statistically controlling for frequency of practice (measured in daysper month) and trait mindfulness.

Results

Frequency of Contemplative Practice

Respondents reported training in nine contemplative practices: an unspecified form of mind-fulness meditation (n = 90, 76.3%), Yoga (n = 43, 36.4%), MBSR (n = 41, 34.7%), Shamatha-Vipassana (n = 37, 31.4%), MBCT (n = 18, 15.3%), Zazen (n = 13, 11%), centering prayer (n =10, 8.5%), Tai Chi (n = 9, 7.6%), and Dzogchen (n = 7, 5.9%). The average length of practice wasreported in years (M = 10.16, SD = 8.00), and the average frequency of practice was reportedin days per month (M = 21.87, SD = 8.83) as well as hours per week (M = 3.54, SD = 1.77).One hundred and eight respondents (91.5%) reported having formal training in mindfulnessmeditation.

Mindful Reappraisal Coping 5

Table 1Frequency With Which Respondents Report Using Mindfulness to Make Positive Reappraisals

Mindfulness helped me to Mindfulness helped me toMindfulness helped me to realize that I can grow notice pleasant things in the

see the positive side of stronger from difficult face of difficultdifficult situations. circumstances. circumstances.

n (%) n (%) n (%)

How often do you use mindfulness to cope in this way?Almost always 1 (1) 5 (4) 1 (1)Often 10 (9) 22 (19) 9 (8)Sometimes 49 (42) 39 (33) 54 (46)Rarely 44 (37) 31 (26) 41 (35)Never 14 (12) 21 (18) 13 (11)

Mindfulness Reappraisal Use Among Meditation Practitioners

Table 1 presents respondents’ frequency of using mindfulness to make positive reappraisals.The majority of contemplative practitioners used mindfulness to make positive reappraisals:51% (n = 60) reported using mindfulness to (a) “see the positive side of difficult situations”sometimes to almost always; 56% reported (n = 66) using mindfulness to (b)“realize that I cangrow stronger from difficult circumstances” sometimes to almost always; and 54% (n = 64)reported using mindfulness to (c) “notice pleasant things in the face of difficult circumstances”sometimes to almost always. There were a small percent of respondents who reported neverusing mindful reappraisal as described by items (a) 12% (n = 14), (b) 18% (n = 21), or (c) 11%(n = 13). Mindful reappraisal frequency did not significantly differ by the type of contemplativepractice used (F = .62, P = .65).

Correlations Between Mindful Reappraisal, Meditation Experience, and Mental Health

Pearson bivariate correlations were computed to investigate the relationship between meditationexperience, duration of mindfulness practice, frequency of practice, and mindful reappraisalfrequency. Mindful reappraisal frequency total score was significantly correlated with practiceexperience (years of mindfulness practice; r = .31, p = .01), meditation practice days per month(r = .30, p = .001), and meditation hours per week (r = .30, p = .001). Mindful reappraisalfrequency was also significantly positively correlated with well-being (r = .42, p <.001) and traitmindfulness (r = .39, p <.001), as well as significantly negatively correlated with the DASS (r =−.34, p < .001).

Prediction of Mental Health by Mindful Reappraisal

Table 2 presents the multiple regression model results. After controlling for frequency of medita-tion practice and trait mindfulness, mindful reappraisal frequency explained significant portionsof variance in well-being, R2 = .19, F(3,110), P < .001, and psychological distress, R2 = .23,F(3,108), P < .001.

Discussion

This study demonstrates that a substantial proportion of practitioners who use a wide-rangeof contemplative practices—often based in mindfulness skill development—reportedly engagein mindful reappraisal techniques as a means of coping with serious stressors or the hasslesof everyday life. This finding provides partial support for the hypothesized linkage betweenmindfulness and reappraisal (Garland et al., 2009, 2010, 2011). Our results further indicate thatmindfulness practitioners with greater meditation experience and those who engaged in more

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Table 2Multiple Regression Analyses Predicting Well-Being and Psychological Distress From MindfulReappraisal Frequency, Frequency of Mindfulness Practice (Number of Days Per Month), andTrait Mindfulness

Well-being Psychological distressVariable β β

Mindful reappraisal frequency .34** −.20*Meditation practice frequency .10 .001Trait mindfulness .10 −.38***R2 .19 .24F 8.26** 10.53**

frequent practice of formal mindfulness meditation tended to use mindful reappraisal copingmore often than their less experienced counterparts.

Moreover, practitioners who reported frequent use of mindful reappraisal also endorsed highlevels of trait mindfulness. These findings appear to contradict the recently posed suppositionthat advanced practitioners may be less likely to engage in mindful reappraisal than novices(Holzel et al., 2011; Zeidan et al., 2012). Further, increased use of mindful reappraisal copingwas associated with greater well-being and lower levels of depression, anxiety, and stress, evenafter statistically controlling for trait mindfulness and frequency of mindfulness practice. Thus,irrespective of practitioners’ trait-level propensities towards mindfulness or extent of mindful-ness training, greater use of mindful reappraisal as a means of coping with stressful life eventswas linked with enhanced mental health. These findings suggest that, in and of itself, mind-ful reappraisal–a skill potentially augmented by mindfulness practice–may hold therapeuticpromise. Yet approximately half of the sample reported infrequent or no use of mindful reap-praisal. Thus, a substantial proportion of practitioners used mindfulness to cope with stressthrough means other than reappraisal. To be clear, a variety of nonevaluative mindful emo-tion regulatory strategies have been proposed, including decentering, attentional control, andrelaxation, among others (Chambers, Gullone, & Allen, 2009; Chiesa et al., 2013).

Although the results from our sample of diverse mindfulness practitioners provide tentativesupport for our hypotheses, the study had a number of limitations. First, mindful reappraisalwas assessed with a set of novel question items that have not yet been validated in the literature;however, these items evidenced good internal consistency and concurrent validity in the currentstudy. Second, the findings are cross-sectional and observational; hence, no causal inferences canbe drawn between mindfulness practice and reappraisal. Indeed, it is possible that individualsinclined toward positively reappraisal may be more likely to engage in mindfulness practice.Nonetheless, the growing body of literature on mindful reappraisal indicates that the ability toreappraise challenging situations is enhanced by mindfulness practices (Garland et al., 2011;Gootjes et al., 2011; Huston et al., 2011; Troy et al., 2012).

Third, the generalizability of the findings may be limited due to the lack of diversity in oursample: The majority of respondents were highly educated and Caucasian. Study results maynot generalize to persons of other racial, cultural, and socioeconomic backgrounds. Similarly,certain mindfulness practices (e.g., centering prayer) are underrepresented in the sample. Studyfindings on mindful reappraisal use may not apply equally across all types of mindfulnesspractices. Finally, given the voluntary nature of the online survey, participants self-selected inthe study; therefore, they may not be representative of the total pool of meditation practitionersincluded in the listserv.

Future studies should employ more diverse samples to explore the use of mindful reappraisalcoping across a wider scope of practitioners. As certain mindfulness practices place greateremphasis on cognitive processes (e.g. MBCT), whereas others deemphasize discursive cognition(e.g. Zen), such research could examine matched samples of practitioners to quantify andqualify differences in the use of mindful reappraisal by specific practice traditions. Moreover,

Mindful Reappraisal Coping 7

future research should utilize randomized controlled designs, whereby novices are allocated to amindfulness-based intervention or an active control group, and then assessed before, during, andafter the intervention sessions to explore how the use of mindful reappraisal coping changes overtime in response to mindfulness training. While the evidence base for the association betweenmindfulness and reappraisal continues to grow, more research is needed to clarify the linkagesbetween these distinct yet complementary factors.

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