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Mindfulness and meditation have a rich historical tradition, and a growing scientific base of evidence supports their use in creating positive psychological and neuroplastic changes for practitioners. Although meditation can be taught in various ways, the scientific community has yet to systematically study the impact of different types of meditation on neuropsychological outcomes, especially as it pertains to digital implementation. Therefore, it is critical that the instruction of mindfulness be evidence based because meditation is being used in both scientific and clinical settings.
This study investigated the use of teacher cueing and the integration of neuroscience education into a meditation program. Compassion cueing was chosen as the element of experimental manipulation because traditional lineages of Buddhist meditation teach compassion for self and others as one of the primary outcomes of meditation. We hypothesized that participants receiving compassion cueing would have enhanced neuropsychological outcomes compared with those receiving functional cueing and that gains in neuroscience knowledge would relate to positive neuropsychological outcomes.
Participants (n=89) were randomized to receive either functional cueing (control group) or compassion cueing (experimental group) and engaged with five 10-minute meditation sessions a week for 4 weeks. All intervention sessions were administered through digital presentation. All participants completed ecological momentary assessments before and after the daily intervention, as well as pre- and postintervention questionnaires.
Participants demonstrated significant benefits over time, including increased mindfulness and self-compassion, decreased depression, and gains in neuroscience content (all
We developed a novel neuroscience-based education–meditation program that enhanced self-regulation as evidenced by improved mindfulness, self-compassion, and mood state. Our findings demonstrate the behavioral importance of engaging with mindfulness meditation and reinforce the idea that the benefits of meditation are independent of teacher cueing behavior. Future studies will need to investigate the brain-based changes underlying these meditation-induced outcomes.
Mindfulness and meditation have a rich historical evidence base, originating in Asia as part of Buddhist and yogic traditions [
Meditation is a self-regulatory practice of the body and mind that can be performed in various ways and is a nonpharmaceutical low-cost tool that can be integrated into a healthy lifestyle [
The use of mindful meditation is not standardized [
In this single-blind randomized controlled trial (RCT), we explored how teachers of mindfulness use their words and curriculum to guide and instruct meditation to optimize psychological outcomes, including mindfulness, compassion, self-compassion, and mental health. Although meditation can be taught in many different ways, we chose compassion cueing as the element to manipulate because traditional lineages of Buddhist meditation teach compassion for self and others as one of the primary outcomes of meditation [
To be eligible for the study, participants were required to be aged ≥18 years and be fluent in English. The exclusion criteria were active trauma or diagnosed and untreated psychiatric illness, which were both self-reported through an initial screening questionnaire developed by the investigators. Recruitment was conducted using social media platforms, other web-based forums, and through in-person announcements by Virginia Tech faculty members who were teaching related content (ie, mindfulness and meditation). The recruitment language included an invitation to practice meditation in the participant’s own home, learn the neuroscience supporting mindfulness meditation, and contribute to new scientific discoveries. Participants were compensated up to US $25 for their participation, with proration occurring at US $2.50 for the pretest assessment, US $1 for each day of meditation, and US $2.50 for the posttest assessment.
The institutional review board at Virginia Tech reviewed and approved this study (IRB-20-799), and all participants completed informed consent.
This study was a 4-week RCT, with participants randomized to receive either meditation with functional cues (control group) or meditation with self-compassion cues (experimental group). Participants were randomly assigned to the groups through a web-based random number generator. Participants completed pre- and posttest questionnaires along with daily acute assessments. This RCT was partially blinded because the investigators knew participant group assignment; however, participants were unaware of their group assignment. The study included 10-minute meditation sessions 5 days a week. Each day, participants were instructed to watch a 10-minute prerecorded education-meditation video. The control group received standard functional meditation directions (ie, “If you are distracted, return to the mantra.”), whereas the experimental group received functional meditation directions and additional self-compassion cues (ie, “When you are distracted, remember that’s okay. Try to return to the mantra.”). Both groups received identical neuroscience education portions of this study. Participants engaged in neuropsychological assessments before and after the 4-week intervention. In addition, participants completed momentary assessments before and after the presentation of the daily education-meditation video.
The weekly schedule included a scaffolded curriculum and was the same for each of the 4 weeks. Day 1 included 7 minutes of neuroscience education and 3 minutes of meditation. Days 2, 3, and 4 included 5 minutes of neuroscience education and 5 minutes of meditation. The final day of the week was a 10-minute meditation practice (
The education-meditation curriculum was designed by a PhD neuroscientist and an experienced meditation teacher with >10,000 hours of teaching experience. The first week of the curriculum focused on attentional control and used focused attention meditation. Focused attention meditation used the mantra or repeated phrase, “I am alive. I am at ease.” The second week of the curriculum focused on emotional control and used an open monitoring meditation. This technique, called
Weekly schedule for the division of time spent in the intervention. This schedule was repeated 4 times, with a new meditation technique provided weekly.
Day | Minute | |||||||||
|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
1 | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Meditation | Meditation | Meditation |
2 | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Meditation | Meditation | Meditation | Meditation | Meditation |
3 | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Meditation | Meditation | Meditation | Meditation | Meditation |
4 | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Neuroscience education | Meditation | Meditation | Meditation | Meditation | Meditation |
5 | Meditation | Meditation | Meditation | Meditation | Meditation | Meditation | Meditation | Meditation | Meditation | Meditation |
How neuroscience concepts, meditation style, and meditation techniques were related and utilized in this study design.
|
Week 1 | Week 2 | Week 3 | Week 4 |
Neurosciencea | Attentional control | Emotional regulation | Self-awareness | Self-regulation |
Meditation styleb | Focused attention | Open monitoring | Embodiment | Breath control |
Meditation technique | Mantra | Movie of the mind | Hand turning | Observing the breath |
aAll groups received the same neuroscience curriculum.
bDuring meditation, the control group received functional cues, and the experimental group received functional cues plus compassion cues.
Regarding the weekly flow of the experiment, participants received an email (on a Sunday) with a link to begin their education-meditation program on the following day. Clicking on the provided link brought the participants to a Qualtrics survey with 3 daily questions:
“How are your thoughts?”
“How are your feelings?”
“How is your body?”
The questions were answered on a standard 10-point Likert scale ranging from 1=“Settled
Time spent watching the 10-minute video was monitored in Qualtrics with a clock feature on the embedded video page: <10 minutes meant that the participants did not complete the session, and >10 minutes suggested that they may have been distracted with other tasks or fallen asleep. Participants displaying inconsistent times more than once (3/89, 3%) were removed from the study.
The Beck Anxiety Inventory (BAI) is a self-report measure of anxiety symptoms [
The Beck Depression Inventory (BDI) is a self-report measure of depression symptoms, with >25 years of validity testing [
The Five-Facet Mindfulness Questionnaire (FFMQ) is a self-report measure of trait mindfulness behaviors and mindful thought patterns (Baer et al [
The Mindful Attention Awareness Scale (MAAS) measures core qualities of mindfulness and consciousness [
The Self-Compassion Scale (SCS) was created by Neff [
The Compassion Scale (CS) is a self-report measure of one’s kindness and desire to lessen the struggle of others [
To assess neuroscience knowledge, we created the Neuroscience Knowledge Check (NKC) to partner with content presented in the education portion of this study (
An a priori power analysis was run using G*Power (version 3.1; Heinrich Heine University) to determine the appropriate number of participants to power this study. We used an
Repeated measures ANOVAs with within-between interactions were conducted to examine the hypothesis that teacher behavior (ie, compassion cueing) significantly enhanced mindfulness (ie, FFMQ and MAAS), compassion (ie, CS and SCS), and mental health (ie, BAI and BDI) outcomes in the experimental group compared with the control group. We additionally used Pearson product-moment correlations to test the hypothesis that greater gains in neuroscience knowledge (ie, NKC) would be significantly associated with greater changes in mindfulness, compassion, and mental health outcomes and further that these outcomes of interest would be significantly correlated to one another. Paired samples 2-tailed
Of the 89 participants in this study, 65 (73%) were women, 67 (75%) identified as White, and 52 (58%) were novice meditators. The participants represent diverse annual income, education, and marital status (
Demographic data for all participants (N=89).
Category | Participants, n (%) | ||
|
|||
|
Female | 65 (73) | |
|
Male | 23 (26) | |
|
Intersex | 1 (1) | |
|
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|
Asian | 13 (15) | |
|
Black or African American | 5 (6) | |
|
Other | 4 (4) | |
|
White | 67 (75) | |
|
|||
|
Hispanic | 2 (2) | |
|
Non-Hispanic | 87 (98) | |
|
|||
|
Advanced degree | 65 (73) | |
|
Bachelor’s degree | 19 (21) | |
|
Some college | 4 (4) | |
|
Finished high school | 1 (1) | |
|
|||
|
None | 14 (16) | |
|
Novice | 52 (58) | |
|
Intermediate | 20 (22) | |
|
Advanced | 2 (2) | |
|
Expert | 1 (1) | |
|
|||
|
Divorced | 8 (9) | |
|
Living with significant other | 10 (11) | |
|
Married | 44 (49) | |
|
Single (never married) | 26 (29) | |
|
Widow or widower | 1 (1) | |
|
|||
|
<15,000 | 3 (3) | |
|
15,000 to 24,999 | 11 (12) | |
|
25,000 to 34,999 | 7 (8) | |
|
35,000 to 49,999 | 14 (16) | |
|
50,000 to 74,999 | 6 (7) | |
|
75,000 to 99,999 | 14 (16) | |
|
100,000 to 149,000 | 14 (16) | |
|
150,000 to 199,999 | 8 (9) | |
|
≥200,000 | 11 (12) | |
|
|||
|
Homemaker | 4 (4) | |
|
Not working | 7 (8) | |
|
Retired | 13 (15) | |
|
Working full time | 46 (52) | |
|
Working part time | 19 (21) |
No significant interaction (time × group) effect was found for any of our primary outcomes of interest (
In addition, a significant time effect was found for self-compassion (
A significant time effect was also found for depression (
Finally, a significant time effect was found for neuroscience knowledge (
Neither time effects nor time × group effects were significant for anxiety (BAI), compassion (CS), or dispositional mindfulness (MAAS;
Pre- and posttest measurements for groups receiving either functional cueing or compassion cueing (n=89 for all tests). The education-meditation program significantly improved (A) mindfulness, (B) self-compassion, (C) depression, and (D) neuroscience knowledge. All time effects are significant at
As no significant time × group differences were established for measurements assessed before and after the intervention, the following data were analyzed across groups. Daily scores were significantly lower after the meditation than those before the meditation on all days (
Change scores from before to after the daily education-meditation practice demonstrated a statistically significant effect over the 20 days of the intervention (
As the intervention provided a unique meditation each week, we additionally visualized and analyzed the data on a per-week basis (
Mean (SE of the mean) of the total daily score, combining thoughts, emotions, and body from settled to active both before (black line) and after (gray line) watching the daily education-meditation video. All values are significant at
Absolute change scores, represented as mean (SE of the mean), for aspects of thoughts, emotions, and body from before to after the education-meditation practice. Larger values represent larger shifts in the direction from active to settled.
Percentage change towards settled from before to after the education-meditation practice for thoughts, emotions, and body during each week of the intervention.
Regarding the relationship among meditation outcomes, statistically significant correlations were found between the change in FFMQ and the change in CS (
Furthermore, total daily change scores (after meditation minus before meditation) demonstrated significant correlations with the change in FFMQ (
Pearson product-moment correlation coefficients (top right), histograms (diagonal), and correlation scatterplots (bottom left) demonstrating the relationships among the changes in our primary outcomes of interest from before to after the intervention. Outer edge scales represent the range of total response for each individual scale. BAI: Beck Anxiety Inventory; BDI: Beck Depression Inventory; CS: Compassion Scale; FFMQ: Five-Facet Mindfulness Questionnaire; SCS: Self-Compassion Scale. *
This study examined the effect of adding compassion cueing to a neuroscience-based mindfulness meditation practice on various neuropsychological outcomes. We found that although compassion cueing did not enhance our outcomes of interest, the practice of meditation enhanced mindfulness, increased self-compassion, and decreased levels of depression. Importantly, we found that those individuals who gained the most in terms of mindfulness showed the largest gains in compassion, self-compassion, and mental health. In addition, we found that although our intervention improved neuroscience knowledge, this new knowledge was not correlated to our neuropsychological outcomes of interest. Finally, we found that the acute effects of meditation were related to the long-term effects of meditation: those who gained the most in terms of acute effects benefited the most in the long term. Although our neuropsychological findings are consistent with existing literature [
Our results are consistent with existing literature demonstrating that meditation is a powerful tool to improve neuropsychological function, with the most significant positive impacts seen in self-regulatory behaviors [
Similar to our work, previous studies indicate that increased mindfulness leads to improved well-being [
Our novel intervention focused on the teacher’s cueing behavior (ie, functional cueing vs compassion cueing) during meditation and how cueing affected outcomes related to mindfulness, compassion, and mental health. Interestingly, we found that cueing behavior did not have a substantial impact on our outcomes of interest. Rather, we found that it is the practice of meditation itself rather than teacher behavior that affects outcomes. Similar to our work, Condon et al [
This particular outcome of our study is consistent with mindful self-regulation theory [
This intervention included a neuroscience education curriculum, teaching the neuroscience of 4 unique meditation techniques that focused on attention, emotional regulation, self-awareness, and self-regulation (
Although mindfulness has been examined from the perspective of neuroscience [
The daily scores provided insight into how meditation acutely affected thoughts, emotions, and bodily sensations. First, we found that the most prominent acute effects occurred during the first week of the intervention, with thoughts, emotions, and body moving from active to settled from before to after the daily intervention. Subsequently, the total change scores decreased over the 20 days of the intervention; however, this change was related to the long-term beneficial effects of the intervention, that is, as the intervention progressed, participants started their daily intervention in a more settled state, with less room for improvement. This is similar to other work showing that the effects of meditation change as novice meditators gain experience [
Importantly, we found that the acute effects of meditation substantially related to our outcomes of interest. Specifically, those individuals who showed the largest acute benefits (from states of active to settled) showed the largest gains in various aspects of mindfulness, including acting with awareness, nonreactivity, dispositional mindfulness, and self-compassion mindfulness. In addition, those who demonstrated the largest shifts in emotion from active to settled, demonstrated the largest gains in self-compassion. This is the first study that has combined ecological momentary assessment with long-term outcomes to show that the acute effects of meditation are related to the chronic effects.
Although the results of this study are well supported by existing literature and add to existing knowledge, limitations exist. First, this study was conducted on a convenience sample that could have been more diverse. Second, because of technical issues, not all posttest data were collected from every participant, creating unequal sample sizes for some measurements. In addition, many of the predictable neuroplastic changes associated with mindful meditation may take longer to manifest than the duration of 20 days spanning over 4 weeks offered by this intervention. A future iteration of this study should be completed with each of the 4 techniques spanning 2 weeks for a total intervention duration of 8 weeks.
Meditation studies often struggle to have a solid study design and implementation methodology. Among these challenges is finding a suitable control for mindful meditation. We foresee that separating the neuroscience education from the meditation practice will create an excellent mindful meditation education control. In addition, as the intervention did not display any statistically significant differences between the control and experimental groups, future studies should include a comparison of basic cueing versus no cueing.
Finally, this study design included 5 days of meditation spread over a 7-day week. This allowed for the most flexibility from participants. If a day was missed during a traditional weekday, participants could complete their session or sessions on the weekend. Therefore, the effect of the meditation may have been lessened by this break in meditation. In addition, creating a daily routine with less flexibility may prove easier for participants. Future study designs could include (1) 20 consecutive days or (2) a longer intervention with 40 mindful meditation sessions over 8 weeks to investigate the effect of meditation dosage.
This study, which used a novel neuroscience-based education–meditation program, demonstrated the behavioral importance of engaging with mindfulness meditation to optimize individual well-being through improved mindfulness, self-compassion, and depression symptomatology, suggesting enhanced self-regulation. This study additionally reinforces the idea that the benefits of meditation are independent of teacher cueing behavior. These neuropsychological changes are likely supported by neuroplastic changes associated with mindfulness meditation, but future work will need to investigate the brain-based outcomes. Finally, this study newly demonstrates that the acute effects of meditation translate into longitudinal outcomes. Future studies will need to systematically investigate the inclusive use of the neuroscience curriculum as well as test the effects of other types of teacher cueing.
Neuroscience knowledge questionnaire (administered both before and after the intervention).
Mean (SE of the mean) for all neuropsychological outcomes of interest for both groups both before and after the intervention. Time and time × group effects are presented. All statistically significant effects are highlighted in bold.
Ecological momentary assessment scores from before to after the daily education-meditation practice demonstrated a statistically significant change each day of the intervention. Mean change scores (pre-post assessments) are presented for each day of the intervention. Statistically significant effects are highlighted in bold.
Correlation table for all outcomes of interest, including both ecological momentary assessments and primary endpoints. All statistically significant effects are highlighted in bold.
CONSORT-eHEALTH checklist (V 1.6.2).
Beck Anxiety Inventory
Beck Depression Inventory
Compassion Scale
Five-Facet Mindfulness Questionnaire
Mindful Attention Awareness Scale
Neuroscience Knowledge Check
randomized controlled trial
Self-Compassion Scale
This work was supported by the integrated Translational Health Research Institute of Virginia (iTHRIV) Scholars Program, which is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR003015 and KL2TR003016). The Statistical Applications and Innovations Group, Department of Statistics, Virginia Tech, also supported this work. Finally, this work was supported by Virginia Tech’s Open Access Subvention Fund.
None declared.