Curr Psychol DOI 10.1007/s12144-016-9454-y
Can Specific Attentional Skills be Modified with Mindfulness Training for Novice Practitioners? Rodrigo Becerra 1 & Coralyn Dandrade 1 & Craig Harms 1
# Springer Science+Business Media New York 2016
Abstract Mindfulness practice is becoming an accepted psychological intervention used in clinical settings to help enhance attention. To date however relatively few randomised control trial (RCT) studies have investigated the effect of mindfulness training on attentional skills in novice practitioners. This study examined the effect of daily mindfulness practice on changes in attention skills; alerting, orienting and executive control in novice practitioners. Forty six university students from Perth, Western Australia were randomly assigned to one of two groups (mindfulness or waitlist control). Baseline analyses of psychological wellbeing indicated that the two groups initially were comparable in this domain. Pre- and post-test assessments using the Attention Network Test (ANT) were conducted to measure attention skills. Repeated measures ANOVA were used to examine the effect of intervention. Significant improvement in orienting and executive control skills following the mindfulness intervention was noted, however, no changes in alerting attentional skills were detected. Mindfulness practice impacted on the fundamental processes of the selective (orienting) and executive attention (executive control) networks which may in turn have additional beneficial effects in a variety of domains and situations. These findings add to existing literature that supports the positive and beneficial effect of regular mindfulness practice for the enhancement of attentional skills and its potential application to clinical populations.
* Rodrigo Becerra
[email protected]
1
School of Psychology and Social Science, Faculty of Computing, Health and Science Edith Cowan University, (Room 30.129), 270 Joondalup Drive, Joondalup Perth, WA 6027, Australia
Keywords Attention . Attention Network Training . Mindfulness . Meditation . Novice practitioners
One of the most widely utilised definitions of Mindfulness is that offered by Kabat-Zinn (1994), namely, paying attention in a particular way, on purpose, in the present moment and nonjudgementally (Kabat-Zinn 1994). Attention appears to be a central component to the various definitions of mindfulness (Shapiro, et al. 2006). In a study examining the subsystems of attention, Jha, Krompinger, and Baime (2007) operationalised mindfulness as Battention that is receptive to the whole field of awareness and remains in the open state so that it can be directed to currently experienced sensations, thoughts and emotions and memories^ (p. 110). Similarly, Shapiro and Carlson (2009) defined mindfulness as B…an awareness that arises through attending in an open, accepting, and discerning way to whatever is arising in the present moment^ (p. 9). While variation in conceptual descriptions and difficulties in operationalising the construct of mindfulness have been noted (Baer 2003; Bishop et al. 2004; Brown and Ryan 2003; Hayes and Shenk 2004) emphasis remains on the importance of paying ‘attention’ to both internal and external experiences. As an underlying function of many psychological disorders and general cognitive functioning, the construct of attention has attracted considerable research interest (Mirsky, Anthony, Duncan, Ahearn, and Kellam 1991; McDowd 2007). There are numerous theories on attention but the most consistently referred to is that by Posner and Peterson (1990) who suggested that attention consists of three functionally distinct neural networks, defined as orienting, detecting, and alerting. In an update of their original conceptualisation, the authors changed the descriptor of Bdetecting^ to Bexecutive^ attention (Petersen and Posner 2012). Crudely put, Balerting^ is the process of achieving and maintaining an alert state of vigilance
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over time; orienting is the ability to prioritize sensory input by selecting modality or location; and executive attention prioritises between competing thoughts, feelings and responses (Petersen and Posner 2012). Fan et al (2009) endorse this notion of attention and added that although they have been traditionally interpreted as separate networks, there is evidence of possible behavioural interaction and integration. Earlier, Fan and colleagues (2002) tested the independence dimension of the attention network with the Attention Network Test (ANT). As a speeded computerised choice task, the ANT provides a measure of reaction time for the attention skills of alerting, orienting and executive control during the course of three separate trials. The ANT has become an increasingly popular test used to assess the attention network function in diverse mental health populations (MacLeod, et al. 2010). In order to examine the function and utility of attention in mindfulness practice, numerous empirical studies have utilised the ANT (e.g., Polak 2009; Tang, et al. 2007; Zylowska, Smalley, and Schwartz 2008) including behavioural and neuroimaging measures (Chiesa, et al. 2011; Shapiro, Carlson, Astin, and Freedman 2006). Evidence suggest that while mindfulness practice activates and modifies the subcomponents of attention (Jha et al. 2007) individual differences are noted as a function of hours of practice (Hodgins and Adair 2010; Lutz et al. 2008a, b; Moore and Malinowski 2009; MacLean, et al. 2010). However, further research is needed before this conclusion can be established with confidence. Indeed, it has been highlighted that more randomised control trials (RCT) studies in this area are needed so the numerous methodological problems encountered thus far, are properly addressed (Brefczynski-Lewis et al 2007).
Experienced and Novice Practitioners Behavioural and neurological studies comparing experienced and novice practitioners suggest that regular and continual mindfulness practice is associated with enhanced attentional functioning and cognitive flexibility (Moore and Malinowski 2009; Jha et al. 2007). Lutz et al. (2004) used neuroimaging measures to compare the attention networks of expert practitioners to novice practitioners and observed that mindfulness practice can significantly affect attention and brain function; however comparison studies between long term and novices practitioners may be compromised by not differentiating specific attentional domains. Similar findings were identified by Jha et al., (2007) who, using the ANT, noted that experienced participants demonstrated better executive attention skills compared to the novice and control groups, whilst novice participants demonstrated improved orienting skills compared to both other groups. Only experienced participants demonstrated improved alerting skills compared to both novice and control groups.
A study by Brefczynski-Lewis and colleagues (2007) used magnetic resonance imaging (MRI) to monitor neural activation while performing a focused attention task in experienced and novice practitioners as well as relaxation controls. Results indicated greater activation in neural networks associated with attention in all participants; however variation was evident in the strength and time course of activation related to experience. Both novice and experienced practitioners showed greater activation across all attentional network areas of the brain compared to the relaxed condition. Interestingly, experienced practitioners with over 19,000 h of practice showed stronger activation in the alerting network compared to novices, while experienced practitioners with over 44,000 h practice showed less. A correlation analysis indicated a negative relationship between activation of the attention networks and hours of practice. The researchers suggested that expertise in mindfulness practice may lead to decreased activation in the attention network due to increased processing efficiency. Collectively taken, these results support the notation of Wallace (2006) that as novice practitioners are faced with the challenges of mind wandering, they up-regulate their attention skills to ensure they stay on task. Over time, experienced practitioners develop an acute ability to notice when the mind has wandered such that, at the most advanced levels the regulative skills are invoked less frequently, and the ability to focus attention thus becomes progressively ‘effortless.’ However, as highlighted by Dickenson et al. (2012), more empirical research is needed to confidently establish this proposition. There are two reasons that make the study of the effect short term mindfulness on attention worth pursuing. The first is related to the available evidence. Whilst research has reported attentional improvements in long term mindfulness practice (e.g., Brefczynski-Lewis, et al. 2007; Cahn and Polich 2006), there are only a few studies that have studied comparable outcomes with short term Mindfulness training (e.g., Semple 2010; Tang et al. 2007; Valentine and Sweet 1999; Zeidan et al. 2010; Moore et al. 2012; Schofield et al. 2015). For example, Jha and colleagues (2007) compared a group of experienced practitioners who participated in a 30 day intensive mindfulness retreat with a group of novice practitioners participating in an 8 week Mindfulness Based Stress Reduction (MBSR) program. Results from the ANT showed that the MBSR program improved orienting skills, whilst retreat participants showed improvements in alerting skills. The researchers proposed that over time, mindfulness practice might differentially enhance specific components of attention. Similar findings have been reported (See for example, Lutz and colleagues, 2009; Short and colleagues 2007). The second reason is that, many of these studies (e.g., Jha et al. 2007; Tang et al. 2007) include various techniques in addition to mindfulness, making it difficult to establish if mindfulness was the agent of agent. Consistent with this, the need for more RCT using brief mindfulness
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Seventy one undergraduate university students from Perth, Western Australia volunteered to participate in the study. Volunteers were briefly screened and those with previous experience in meditation practice were excluded. That is, participants who have engaged in formal practice of mindfulness (brief or extended) were excluded). Attending a talk or reading about mindfulness was not considered part of our exclusion criteria. Subsequently, participants were randomly assigned to one of two groups according to order of response. Sixty two participants began the study (48 females, 14 males). Twelve females and four males (equally distributed across groups) dropped out before completing the study (70.9 % retention rate) and their data were not included. This dropout rate seems to fit typical dropout rates from group interventions/trainings in general (Edlund, et al 2002; Klein et al. 2003) and more specific Mindfulness programs dropouts rates (e.g., Crane and Williams 2010). In all, forty six participants who ranged between 20 and 61 years of age (M = 33.9, SD = 12.1) completed the study; 23 participants in each group.
The 21-item version of the Depression Anxiety and Stress Scale (DASS 21: Lovibond and Lovibond 1995) was designed to measure the negative emotional states of depression, anxiety and stress. Participants were required to answer twenty one questions on a likert format ranging from 0 being BDid not apply to me at all^ to 3 BApplied to me very much most of the time^. Reliability (as measured by Cronbach’s alpha) has shown to be relatively high by Crawford and Henry (2003): .89 for the anxiety scale; .95 for the depression scale; .93 for the stress scale; and .96 for the total score. To assess attention, the Attention Network Test (ANT – computerised version) (Fan, McCandliss, Sommer, Raz, and Posner 2002) was used. This measure assesses the efficiency of the three subcomponents of attention: alerting, orienting and executive control. The ANT is a computerised assessment instrument which combines a flanker task using arrows with a cued reaction time task (time between stimulus presentation and response). It is a combination of a cued Reaction Time (RT) task (Posner 1980) and the flanker task (Eriksen & Eriksen, as cited in Fan et al 2002). Participants are required to report whether a central arrow points left or right (See Fig. 1a). The arrows could appear above or below a fixation point (see Fig. 1b for an example) but the flanker might not appear at times. The test consists of a 24 trial full feedback practice block and three experimental blocks of trial with no feedback. Each experimental block consists of 96 trials (4 cue conditions × 2 target locations × 2 target directions × 3 flanker conditions × 2 repetitions) which occur in random order. To calculate the alerting network score, RT in the double cue condition is subtracted from RT in the no cue condition (average across flanker conditions). Cue conditions were introduced with an asterisk (*). There are three cue conditions (centre cue, double cue, and spatial cue) (see Fig. 1b for a representation of the cure conditions). For the orienting network score, RT in the cue condition is subtracted from RT in the central cue condition (averaging across all conditions). The executive control network score is calculated by subtracting RT in the congruent flanker condition from RT in the incongruent flanker condition (averaging across all conditions). Responses are computer scored. Lower scores indicate better performance. Split-half reliability (Spearman–Brown r) of reaction time for the ANT scores have shown to be .38 for alerting, .55 for orientating and .81 for executive control (MacLeod et al. 2010).
Materials
Procedure
A demographic questionnaire was designed to collect information related to participants’ age, gender, years of study, place and year of birth, and previous or current experience in meditation. The following measures were used to establish psychological distress functioning and to assess attention.
The study was granted approval by the Edith Cowan University’s Ethics committee. After obtaining written consent for participation, 23 participants were allocated to the mindfulness-practice group and 23 participants were allocated to the waitlist-controls groups. The self-report measures were
interventions, without including complementary techniques, appears needed. This need has been previously identified (e.g., Tang et al. 2007; Zeidan, et al. 2010); BAlthough research examining the effects of extensive meditation interventions is growing, the effects of brief mental training on mood and cognition are relatively unknown^ (Zeidan, et al. 2010, p 598). Using a sample of university students with no prior experience with mindfulness, the present study measured changes in attentional skills as a function of mindfulness. Based on previous findings, it was hypothesised that novice practitioners who engage in brief mindfulness practice would show improve performance on selective measures of attention as compared to individuals who engage in no practice.
Method Research Design This study used a parallel-groups design. Participants were randomly assigned to one of two groups, mindfulness practice or waitlist controls. Participants
Curr Psychol Fig. 1 a The three cue conditions and b The six stimuli
(a) ___ ___
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____ ____ Neutral
Congruent
Incongruent
(b) ** + +
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+
*
*
No cue
emailed to participants who completed and returned them prior to the pre-test session. During the 1 h pre-test session, participants completed the ANT. Participants allocated to the mindfulness intervention were invited to attend the introductory session for the commencement of the intervention. Waitlist participants were informed that training would be conducted following the post-test session. During the intervention, mindfulness practice was modelled on the basic Samantha skills (Wallace 2006). At the introductory session, participants were instructed to sit in a relaxed upright position, with their eyes closed, and simply focus on the natural flow of their breath as it passed in and out of their nose and down into their body. As thoughts arose, they were directed to just notice and acknowledge the thought, simply let it go and redirect their attention back to the sensations of the breath. As novice practitioners, the participants were instructed to engage in 24 min (Wallace, p.9) of mindfulness practice daily. A prerecorded mindfulness CD and daily diary were given to each participant to guide and record their practice. Practice diaries were distributed as a means to record the daily practice and were collected and checked weekly. All subjects complied with the suggested minimum practice (80 %) or above. Mindfulness practice was conducted with the group each fortnight during the 8 week intervention. At each of the four group practice sessions, practice issues were discussed and clarified before engaging in guided mindfulness practice conducted by the facilitator using the pre-recorded CD. Following completion of the intervention, all participants completed the ANT.
Results All data were collected, screened and analysed using SPSS (v. 20). A series of one way ANOVA’s were conducted on baseline
Centre cue
Double cue
Spaal cue
measures of psychological distress. The groups were found to not differ on symptoms of depression, anxiety, and stress at pretesting (see Table 1). Separate Between-Within ANOVA’s were conducted to compare the performances of the Mindfulness intervention and the Waitlist groups on the attention skills pre and post intervention for the Alerting, Orienting and Executive Control components of the ANT. The descriptive data for the main analyses appears in Table 2. Cohen’s d (Cohen 1992) was reported as a measure of effect size. Significant interactions (group x time) were observed on performance for Alerting, F(1, 44) = 7.75, p = .008, Orienting, F(1, 44) = 164.46, p < .001, Executive Control, F(1, 44) = 70.93, p < .001. An analysis for the simple effects over time for each group revealed that the performance of the Mindfulness group was better (that is, shorter reaction times), and the size of the effects over time were moderate to large, after the intervention compared to the pre-test score for Orienting F(1,44) = 287.50, p =
