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The purpose of this study was to determine whether mindfulness meditation training could reduce pain and distress in a laboratory finger pressure pain task, reduce severity of daily hassles, improve mood, and reduce psychological distress in a community sample. Participants were randomly assigned to one of two conditions: mindfulness meditation intervention or wait list. Participants in the mindfulness meditation intervention condition (n = 16) attended four weekly group sessions training them in the practice of mindfulness meditation. They also were asked to meditate 20 minutes daily. Wait list participants (n = 17) received no intervention. Measures of laboratory pain, daily hassles, mood, and psychological distress were collected from all participants before and after intervention. After two sets of measures had been collected, the wait list participants received the mindfulness meditation intervention. A third set of measures was then collected from the wait list participants. Results indicate that the participants in the intervention condition had decreased severity of daily hassles, improved mood, and decreased psychological distress at the second evaluation compared to the wait list participants. Results also indicate that participants in the wait list had greater decreases in distress for the second half of the laboratory pain task and greater improvements in mood during the intervention versus wait list phases of the study. Taken together, these findings indicate that mindfulness meditation training can reduce severity of daily hassles, improve mood, and reduce psychological distress and may be able to reduce distress during exposure to painful stimuli.

      Meditation can be defined as “the intentional self-regulation of attention from moment to moment” (Kabat-Zinn, 1982). It is not, as is commonly believed, rumination or thinking about a particular topic in a conceptual way, nor is it withdrawal of the senses into a perceptually dormant state (this would be extinction of attention rather than regulation). There are two main types of meditation: concentration practices and mindfulness practices (Kabat-Zinn, 1982). As stated above, both involve the intentional regulation of attention, but the manner in which attention is utilized differs fundamentally between the two types of practice.
      Concentration methods are among the most widely known and researched forms of meditation. Transcendental Meditation (TM) and the relaxation response (Benson & Klipper, 1988) are examples of concentration practices. Concentration practices are characterized by the focusing of attention onto a single object such as a mantra (a mentally repeated phrase), a visual object, or the experience of breathing. The object of concentration is held in the mind throughout the meditation session, and any other type of mental activity is viewed as a distraction to be guarded against.
      Mindfulness meditation¹ has its roots in Theravada Buddhism. Like concentration practices, mindfulness also involves the concentration of attention, but it does not involve focusing attention on one particular object. Instead, mindfulness involves maintaining a moment-to-moment awareness of a constantly changing array of objects. This is accomplished by first stabilizing attention on a primary object (usually the breath) until the mind has settled somewhat and then gradually expanding the field of attention to include all sensory and mental events.² The attentional stance one takes toward these sensory events is the crucial aspect of mindfulness meditation. The individual’s thoughts, physical sensations, emotions, memories, etc. are not to be regarded in such a way as to promote interpretation or judgment of them. Rather they are to be regarded with mindfulness, an attentional stance in which sensations, feelings, and thoughts are observed as separate and distinct from the expectations, desires, or aversions which arise in dependence on them. Equanimity is cultivated as this “choiceless awareness” (Krishnamurti, 1969) or “bare attention” (Goldstein, 1987) that does not judge or categorize perception but rather observes experience as being in moment-to-moment flux. All thoughts and experiences which arise are treated the same; no relative or absolute value is placed upon any of them. This specialized use of attention is the essence of mindfulness meditation. (For a more thorough explanation of mindfulness meditation, refer to Kabat-Zinn (1982).)
      From this description, it should be evident that mindfulness presupposes proficiency in concentration practices. In this regard, it coincides with the central features of TM and the relaxation response, namely a mental device and a passive attitude (Benson & Klipper, 1988). However, mindfulness differs from the concentration practices in that it does not have a constant object of attention. In mindfulness, there is no distraction to be guarded against because any mental event can be taken as the object of mindfulness.

      There is physiological evidence supporting the theory that the experience of pain is a result of three interacting dimensions: sensory-discriminative, affective-motivational, and cognitive-interpretative (Melzack & Wall, 1982). According to the gate control theory of pain, pain signals must pass through a “gate” in the spinal cord that can be closed partially or completely, thus blocking the transmission of pain sensations to the brain (Melzack & Wall, 1982). Activities in the affective and cognitive domains (e.g. distraction, hypnosis, or relaxation) can send descending signals from the brain to the spinal cord which close the gate and affect the sensory dimension of the pain experience.
      Intensive practitioners of meditation may experience pain caused by sitting motionless for long periods of time, often in a cross-legged position. Traditional meditation texts contain instructions for cultivating equanimity toward this sometimes intense pain through the specialized regulation of attention which characterizes mindfulness meditation (Nyanaponika, 1962). Kabat-Zinn (1982) suggests that insights gained from the observation of pain arising during meditation might serve as a model for a strategy that patients may use for coping with chronic pain. The present author suggests that people not suffering from chronic pain might also use these meditative insights to develop a strategy for coping with acute pain which they may experience.
      Mindfulness meditation requires focusing on unpleasant and painful sensations when they are present and discourages attempts to escape them by distraction or by focusing on some other object of attention (Kabat-Zinn, 1982). The success of this technique as a pain coping strategy would depend upon the ability of the person to maintain a stance of bare attention toward the sensations, that is, to be able to separate the sensory dimension of the pain experience from the other dimensions and to view the physical sensation with equanimity. With practice, the person could develop the ability to assume this attentional stance toward physical sensation when it became dominant in the field of awareness and to similarly observe the accompanying but independent cognitive processes which lead to the evaluation and labeling of the sensation as painful. According to this understanding of mindfulness meditation, one would expect the nociceptive signals to remain undiminished, but the emotional and cognitive components of the pain experience to be reduced.
      Kabat-Zinn developed a Stress Reduction and Relaxation Program (SR&RP)³ which employs a 10-week training program in mindfulness meditation for patients who are referred by their physicians (Kabat-Zinn, 1982). Chronic pain is one of the primary reasons for referral to the program. Patient outcomes for the SR&RP have provided tentative support for the use of mindfulness meditation as a therapy for chronic pain (Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney, 1985; Kabat-Zinn, Lipworth, Burney, & Sellers, 1986). However, this research did not employ random group assignments. In addition, the SR&RP also included training in Hatha Yoga, which may effectively reduce pain by itself (Garfinkel, Schumacher, Husain, Levy, & Reshetar, 1994).
      Leventhal and Everhart (1980) have proposed a “parallel processing” model of pain which is useful in understanding how mindfulness meditation might elicit changes in pain perception. According to this model, sensations produced by painful stimuli can be processed in two ways: as objective sensations or as distressing, painful sensations. To the extent that persons can conceptualize the sensations in an objective rather than a distressing way, the emotional upset that usually accompanies the experience of those sensations is reduced. Laboratory studies using the cold pressor stimulus have shown that a strategy of attention to primary sensation during exposure to painful stimulus results in significantly less distress and higher tolerance than strategies of distraction or emotional expression (Ahles, Blanchard, & Leventhal, 1983). Participants assigned to the attention group in this study were not given any training but were simply told to describe aloud the sensations that they were experiencing. Pain ratings did not differ significantly between groups, but the distress ratings dropped significantly for the attention group in relation to the other groups beginning at around two minutes. McCaul and Haugtvedt (1982) produced analogous decreases in distress beginning after two minutes of stimulus exposure and also found that attention to sensation becomes a relatively better coping strategy as the trial becomes longer.
      It has been suggested that mindfulness meditation represents a more robust strategy of observing sensations than that used in the above studies and that, as a result, it might produce more dramatic decreases in distress (Kabat-Zinn, et al., 1985). A previous study of concentration meditation comparing the responses of practitioners of TM with non-practitioners during acute cold pressor pain revealed that meditators reported significantly lower levels of distress but not pain (Mills & Farrow, 1981). However, the present study is the first randomized controlled study to investigate the effects of mindfulness meditation upon laboratory trials involving acute pain stimulation.

      Previous research has established the ability of concentration meditation to decrease stress via the relaxation response (Benson, 1983; Delmonte, 1984) and has suggested that mindfulness meditation can reduce stress-related symptoms such as tension headache (Sharma, Kumaraiah, Mishra, & Balodhi, 1990). However, no research has been conducted examining the effects of mindfulness meditation on perceptions of daily hassles. Daily hassles are defined as the relatively minor stresses that characterize everyday life (Kanner, Coyne, Schaefer, and Lazarus, 1981). These day-to-day events may be a good global indicator of stress and have been found to be better predictors of health outcomes than other forms of stress measurement (Kanner, et al., 1981). There are now standard ways of measuring daily hassles, such as the Hassles Scale (Kanner, et al., 1981).
      Because all people experience stress arising from daily hassles, it would be of great potential benefit to know if mindfulness meditation was able to attenuate the perception of daily hassles. The specialized use of attention that characterizes mindfulness meditation should result in changes in the cognitive appraisal of daily hassles because in mindfulness meditation, much as in cognitive therapy, external events are observed to be separate from the cognitive and affective processes which they produce. This separation of the components of the experience of daily hassles should lead to decreases in the perception of their severity. Because no controlled studies have been conducted in this area, the present study examined how training in mindfulness meditation affected the perceived severity of daily hassles.

      The effects of meditation on mood have been studied extensively. Mindfulness meditation has been found to result in decreased mood disturbance and depression and increased self-esteem in chronic pain patients (Kabat-Zinn, et al., 1985). Meditation which elicits the relaxation response has also been found to result in reductions in hostility (Barr & Benson, 1984). Again, however, there is an absence of randomized controlled studies examining these effects in community samples. It seems reasonable, however, that the cognitive restructuring involved in mindfulness meditation would elicit favorable changes in mood in normal individuals as well. The possible presence of these effects was examined in present study.

      Mindfulness meditation has been repeatedly found to be helpful in reducing psychological distress. Several authors have reported that meditation can result in decreases in anxiety, panic, and psychological symptomatology in individuals suffering from anxiety disorders or depression (Kabat-Zinn, Massion, Kristeller, Peterson, Fletcher, Pbert, Lenderking, & Santorelli, 1992; Kutz, 1985). No studies have been conducted in community samples, but it seems reasonable that similar results would be found in normal individuals practicing mindfulness meditation. Therefore, the present study examined changes in psychological distress accompanying training in mindfulness meditation.

      Because of the lack of randomized controlled research on mindfulness meditation in community samples, it seemed worthwhile to investigate the effects mindfulness meditation might have on pain perception, daily hassles, mood, and psychological distress. In the study presented here, participants attended a four-week mindfulness meditation training program. Before and after the training, they were exposed to a laboratory finger pressure pain task in order to see how meditation training affected their ratings of pain and distress. It was anticipated that ratings of distress (but not ratings of pain) during the finger pressure task following meditation training would decrease after two minutes of stimulus exposure. Participants also filled out questionnaires before and after the training in order to examine effects on daily hassles, mood, and psychological distress. Decreases in severity of daily hassles were expected along with overall improvements in mood and psychological distress.

      Thirty-three community volunteers (21 female and 12 male) were recruited through fliers and newspaper advertisements. Participants were not compensated for study participation. This research was conducted in accordance with the ethical standards of the American Psychological Association for research involving human participants.
      The average age of participants was 29.36 years (SD = 11.69). The ethnic distribution was 76% Caucasian, 9% African American, 9% Asian American, and 6% other. The highest level of education of participants was as follows: 21% held a master’s degree, 33% held a bachelor’s degree, 6% held an associate’s degree, 33% were currently enrolled undergraduates, and 6% held a high school diploma. No participants had a regular meditation practice regimen prior to entering the study. Participants were randomly assigned to one of two groups: meditation intervention (n = 16) or wait list control (n = 17). Because it was believed that pain and distress ratings might be affected by gender (Dubreuil & Kohn, 1986) and handedness (Haslam, 1970), participants were grouped by these variables before being randomized.

      The mindfulness meditation training program consisted of four weekly group sessions each lasting for two hours. The content of sessions was based partly on that of the SR&RP. Participants received instruction in the method and practice of mindfulness meditation, were presented with didactic material relating meditation to physical and psychological well-being, engaged in walking and sitting meditation, and participated in open question and answer sessions intended to help troubleshoot difficulties related to their practice. A non-goal orientation was emphasized as being the best approach for practicing mindfulness and the best way to benefit from it. Each session focused on a different aspect of mindfulness practice.
      The first session explained the relaxation response and the potential health benefits to be gained from meditation practice. Mindfulness meditation was introduced as a powerful vehicle for self-inquiry and self-understanding based on moment-to-moment awareness. Breath awareness meditation was taught as a method for concentrating and stabilizing the mind, and participants were guided through a 20-minute sitting meditation. The session ended with an open question and answer period. Participants were then given an audio tape containing a 20-minute guided meditation and were asked to meditate for 20 minutes a day either with or without the tape. Participants were also given meditation diaries to keep track of their practice and to record anything that they wanted to discuss during the group sessions.
      The second session focused on how mindfulness can be applied to physical sensations and to emotions. The session began with an open question and answer period in which participants received help troubleshooting difficulties or addressing questions they had about the practice. After this, an explanation of the gate control theory of pain perception was given, followed by a discussion of the malleability of physical and emotional experience. Mindfulness of sensations was introduced as a method of developing a non-judging awareness of one’s experiences. Participants were guided in a 20-minute sitting meditation which consisted of breath awareness and awareness of sensations and feelings. This was followed by a 10-minute walking meditation to further practice awareness of sensations. The session concluded with another open question and answer period.
      The third session focused on the application of mindfulness to one’s thoughts. Following an initial question and answer period, there was a presentation on the role thoughts play in shaping our experiences and on how differences in the cognitive labeling of a stimulus can lead to very different experiences of that stimulus. A “noting” method of becoming aware of the presence of thoughts without becoming caught up in their content was taught as a way of cultivating mindfulness towards thoughts. Participants were led in a 20-minute sitting and 10-minute walking meditation that reinforced all of the mindfulness techniques that had been taught so far. An open question and answer session followed.
      During the fourth session, the topic of integrating mindfulness into everyday life was addressed. The session began with an open question and answer period. This was followed by a discussion of changes participants had noticed in their daily activities since beginning to practice mindfulness meditation. There was then a presentation on how mindfulness could be cultivated during ordinary daily activities in order to bring a greater fullness to the meditation practice. Participants were asked to share stories related to the practice of mindfulness during ordinary activities and how this affected how they felt during the activity. The session ended with a question and answer session, and participants were given a list of readings and resources related to mindfulness meditation.

      Upon arriving at the laboratory, participants were informed that the purpose of the study was to examine the effects of mindfulness meditation on pain perception, daily hassles, mood, and psychological distress. Participants read and signed consent forms explaining the purpose, method, and requirements of the study, including that the study would involve exposure to a laboratory finger pressure pain task. After consenting, participants participated in an evaluation session in which they completed a biographical information form, the Hassles Scale, the POMS, the SCL-90-R, and the laboratory finger pressure pain task. Participants in the intervention group entered the four week mindfulness meditation training program. Participants in the wait list group received no intervention during the initial four week period. After the initial four weeks had elapsed, all participants returned to the laboratory for a second evaluation session in which the same measures used in the initial session were collected. Following the second evaluation, participants in the wait list group received the four week mindfulness meditation training program and then returned to the laboratory for a third evaluation session.

Hassles Scale
      The Hassles Scale (Kanner, et al., 1981) is a 117-item self-report questionnaire designed to measure the impact of minor hassles of everyday life in the areas of work, family, social activities, finances, etc. (e.g. “concerns about owing money,” “having to wait,” and “job dissatisfactions”). Participants were asked to circle each hassle they had experienced in the past month, leaving blank all items that were not applicable to them. For each item circled, participants rated the severity of the hassle on a three-point scale (1 = “somewhat severe,” 2 = “moderately severe,” 3 = “extremely severe”). The numeric values of the responses were summed to derive a total hassles score, the Cumulated Severity Index (CSI). Test-retest reliability and construct validity of the Hassles Scale have been supported in previous research (DeLongis, Coyne, Dakof, Folkman, & Lazarus, 1982; Kanner et al., 1981).

Profile of Mood States
      The Profile of Mood States (POMS; McNair, Lorr, & Droppleman, 1971) is a self-report questionnaire that measures mood on several subscales. The POMS Short Form used in this study consists of a list of 30 words describing feelings people have. Participants were asked to rate each item on a five-point scale (0 = “not at all” to 4 = “extremely”) according to how they had been feeling during the past week. The numerical values of responses are summed to produce scores on the following six subscales: tension-anxiety, anger-hostility, fatigue-inertia, vigor-activity, confusion-bewilderment, and depression-dejection. A Total Mood Disturbance (TMD) score that is a good global estimate of affective state is obtainable by summing the subscale scores (McNair et al., 1971). The POMS has been used extensively to measure mood change in applied clinical research, and its internal consistency, test-retest reliability, and validity have been supported in prior research (Malouff, Schuttle, & Ramerth, 1985; McNair et al., 1971).

Symptom Checklist
      The Symptom Checklist-90-Revised (SCL-90-R; Derogatis, 1983) is a 90-item self-report inventory designed to assess a wide variety of psychological symptoms (e.g. “feeling that people are unfriendly or dislike you,” “sleep that is restless or disturbed,” and “spells of terror or panic”). Participants were asked to rate how distressed they had been by each symptom during the past week on a five-point scale (0 = “not at all” to 4 = “extremely”). The Global Severity Index (GSI) is the mean rating calculated across all 90 items and is the best single indicator of the current level or depth of disorder (Derogatis, 1983). In addition, nine subscales can be derived: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. Internal consistency, test-retest reliability, and concurrent validity for the SCL-90-R have been found to be good (Derogatis, 1983).

Laboratory Finger Pressure Pain Task
      A Forgione-Barber strain gauge pain stimulator (see Figure 1) was used in the laboratory finger pressure pain task (Forgione & Barber, 1971). The device consists of a dull Lucite knife edge (.25 mm thick) attached to an adjustable lever arm. The knife edge exerts a constant pressure on the second phalanx of any finger, resulting in a sensation of slight pressure that gradually builds into a dull, aching pain. The rate at which the sensation becomes painful can be varied by changing the magnitude of weight attached to the lever arm. Investigators have found the Forgione-Barber stimulator to be reliable, to produce sensations that more closely approximate clinical pain, and to be relatively unaffected by vasomotor activity and other extraneous physiological events (Forgione & Barber, 1971; Merskey, 1974). In experimental trials, two weights (40 g and 70 g) were used for pain stimulation. These weights have been used by previous investigators (Malow, West, & Sutker, 1987; Malow, West, & Sutker, 1989). Both weights were externally identical so that participants could not distinguish them visually.⁴ All trials were held between the hours of five o’clock and eight o’clock in the evening in order to avoid possible time of day effects on pain perception (Labrecque & Vanier, 1995).

Figure 1. The Forgione-Barber strain gauge pain stimulator.

      Participants were led into another room for the laboratory finger pressure pain task. The room contained a round table with one chair facing it. On the table lay the Forgione-Barber strain gauge pain stimulator as well as two 11-point visual analog scales, one labeled pain and the other labeled distress. The endpoints of the pain scale were labeled with verbal descriptors (0 = “No pain” and 10 = “Pain as bad as it can be”) as were those of the distress scale (0 = “No distress” and 10 = “Maximum you can imagine”). After being seated, participants were read instructions explaining the trial apparatus and procedure. They were assured that there was no risk of any harm to their finger and that they could stop the trial at any time by saying, “Stop.” Participants were told that their finger would be placed inside the device for four minutes on two separate trials and that there would be a four minute rest between trials. They were instructed to make pain and distress ratings using the visual scales each time the experimenter announced, “Judgment.” Pain was described as “the physical intensity of what you will be feeling,” while distress was “the amount of mental distress or upset that the sensations are causing you.” Participants were told that each rating was independent of the others and that their ratings could go up, down, or remain the same. These instructions were adapted from Leventhal, Brown, Shacham, & Enquist (1979). At no testing session were participants instructed to use mindfulness techniques during the laboratory finger pressure pain task.
      After the instructions were read, the middle finger of the participant’s left hand was inserted into the pain stimulator. The left hands of all participants were used because of prior findings that the left hand is more sensitive to pain regardless of handedness (Murray & Safferstone, 1970). The experimenter placed the 40 g weight on the lever arm and sat approximately 6 feet to the side and rear of the participants so that they would not be distracted by the experimenter’s presence. The experimenter announced, “Judgment,” at twenty second intervals and recorded participants’ verbal ratings of pain and distress. After a four minute rest, the procedure was repeated with the 70 g weight. No participants requested the trial to stop before the maximum four minutes had elapsed for either weight. Two summary scores were calculated for the pain ratings and for the distress ratings: (a) an overall mean which was the mean of ratings given for both weights for the entire trial, and (b) a mean for the last half of the trial which was the mean of ratings given for both weights beginning two minutes into the trial.
      Immediately following the laboratory finger pressure pain task, participants completed a coping strategies checklist that was created to assess whether they had employed distraction, sensory attention, or relaxation techniques during stimulus exposure. The checklist contained three items: (a) “While my finger was in the device, I tried to find other things to look at or think about and to ignore what was going on with my finger”; (b) “While my finger was in the device, I tried to concentrate on all the sensations that it was experiencing--sensations such as stinging, burning, throbbing, etc.”; and (c) “While my finger was in the device, I tried to relax myself in order to keep my pain and distress from increasing.” Participants were instructed to mark each strategy that they had used. It was anticipated that participants employing mindfulness meditation techniques would mark the sensory attention item and perhaps the relaxation item but that they would not mark the distraction item.

      There was no participant loss between the first and second evaluations. However, six participants assigned to the wait list group dropped out of the study between the second and third evaluation sessions when they were scheduled to receive the mindfulness meditation intervention. All of these participants reported having time conflicts with the group sessions. However, the data gathered for these wait list participants during the first two evaluation sessions were retained in analyses.
      Data analysis was conducted in three steps. The first step evaluated pre-intervention differences between the groups. The second step compared outcomes at evaluation 2 for participants in the intervention and wait list groups. The third step examined data collected from participants in the wait list condition to determine if they showed significant changes in outcome during the intervention versus wait list phases of the study.

      Table 1 shows the initial group means and standard deviations for age, gender, handedness, pain and distress ratings, Hassles Scale CSI scores, POMS TMD scores, and SCL-90-R GSI scores. T-test comparisons (or chi-square analyses, as appropriate) were performed on these variables and on all subscales of the POMS and SCL-90-R. There were no significant initial differences between groups on any of these variables.

Table 1
Pre-intervention means and standard deviations for both groups for pain and distress ratings and Hassles Scale, POMS, and SCL-90-R scores

      Notice that the initial levels of distress were very low for both groups. On a scale of 0 to 10, the intervention group reported an overall mean distress level of 1.9 (SD = 1.2) for the finger pressure pain task and a mean of 2.4 (SD = 1.3) for the last half of the finger pressure pain task. Similarly, the wait list group reported an overall mean distress level of 2.4 (SD = 2.1) for the finger pressure pain task and a mean of 2.8 (SD = 2.5) for the last half of the finger pressure pain task.

Effects of Intervention on Pain and Distress During the Laboratory Finger Pressure Pain Task
      Effects of intervention on distress ratings. It was hypothesized that the intervention would result in decreased distress ratings during the last half of the finger pressure pain task. An analysis of covariance (ANCOVA) was conducted to examine post-intervention between group differences in overall mean distress ratings during the finger pressure pain task. In this analysis, participants’ pre-intervention (i.e. evaluation 1) distress ratings were used as a covariate. The results of the ANCOVA revealed that the between group effect was not significant (F(1, 30) = .818, p < .38). Figure 2A displays the adjusted post-intervention (evaluation 2) means for the intervention and wait list groups. As can be seen, participants in the two groups had similar overall mean distress ratings.

Figure 2A. Adjusted post-intervention (evaluation 2) mean distress ratings during the finger pressure pain task.

      To examine if differences in distress ratings were evident for the last half of the finger pressure pain task, a second ANCOVA was conducted examining between group differences in mean distress ratings for the last half of the laboratory finger pressure pain task. The results of this ANCOVA revealed that the between group effect was not significant (F(1, 30) = 1.418, p < .25). Figure 2A displays the adjusted post-intervention (evaluation 2) means for the intervention and wait list groups. As can be seen, the differences between groups in distress ratings for the last half of the finger pressure pain task, although not statistically significant, were in the expected direction and were somewhat larger than the differences between groups for the overall mean distress ratings. To determine if the results differed as a function of the weights beings judged, separate ANCOVA’s were performed on distress rating data collected for the 40 g and 70 g weights individually. No significant between group effects were obtained.
      Effects of intervention on pain ratings. It was hypothesized that the intervention would not have an effect on pain ratings. An ANCOVA was conducted to examine post-intervention between group differences in overall mean pain ratings during the finger pressure pain task. The results of the ANCOVA revealed that the between group effect was not significant (F(1, 30) = .909, p < .35). Figure 2B displays the adjusted post-intervention (evaluation 2) mean pain ratings for the intervention and wait list groups. As can be seen, participants in the two groups had similar overall mean pain ratings.

Figure 2B. Adjusted post-intervention (evaluation 2) mean pain ratings during the finger pressure pain task.

      To examine if differences in pain ratings were evident for the last half of the finger pressure pain task, a second ANCOVA was conducted examining between group differences in mean pain ratings for the last half of the laboratory finger pressure pain task. The results of this ANCOVA revealed that the between group effect was not significant (F(1, 30) = .949, p < .34). Figure 2B displays the adjusted post-intervention (evaluation 2) means for the intervention and wait list groups. As can be seen, participants in the two groups had similar pain ratings for the last half of the trial.
      To determine if the results differed as a function of the weights beings judged, separate ANCOVA’s were performed on pain rating data collected for the 40 g and 70 g weights individually. No significant between group effects were obtained.

Coping Strategies Checklist
      Participants were expected to use more sensory attention strategies and less distraction during stimulus exposure following intervention. Table 2 shows the number of participants marking each item of the coping strategies checklist at each evaluation. As can be seen in the first two columns, the decrease in distraction and increase in sensory attention use for the intervention group was minimal. Chi-square comparisons of the distraction (p < .35), sensory attention (p < .35), and relaxation (p < .15) items were not significant. This suggests that the intervention may not have been effective in increasing participants’ use of mindfulness techniques during the laboratory finger pressure pain task. As expected, the wait list group showed no significant changes between evaluations 1 and 2 on the distraction (p < .27)), sensory attention (p < .72), or relaxation (p < .36) items.

Table 2
Number of participants responding to each item of the coping strategies checklist⁵

Intervention Compliance
      Participants in the intervention group performed the mindfulness meditation practice an average of 4.3 days (SD = 2.1) per week out of the recommended 7 days.

Effects of Intervention on Daily Hassles, Mood, and Psychological Distress
      Effects of intervention on daily hassles. It was hypothesized that meditation training would result in decreased scores on the daily hassles measure. An ANCOVA conducted to analyze the Hassles Scale CSI scores revealed a significant between group effect (F(1, 30) = 11.13, p < .003). Figure 3 displays the adjusted post-intervention (evaluation 2) mean CSI scores. Participants in the intervention group rated the severity of their daily hassles as significantly lower than participants in the wait list group.

Figure 3. Adjusted post-intervention (evaluation 2) mean Hassles Scale CSI scores.

      Effects of intervention on mood. It was hypothesized that meditation training would result in decreased scores on the mood measure. An ANCOVA conducted to analyze the POMS TMD scores revealed a significant between group effect (F(1, 30) = 9.57, p < .004). Figure 4 displays the adjusted post-intervention (evaluation 2) mean TMD scores. Participants in the intervention group reported significantly lower levels of mood disturbance than participants in the wait list group.

Figure 4. Adjusted post-intervention (evaluation 2) mean POMS TMD scores.

      To examine if differences in mood were evident on the subscales of the POMS, a multivariate analysis of covariance (MANCOVA) was conducted. In this analysis, participants’ pre-intervention (i.e. evaluation 1) scores on the POMS subscales were used as covariates. The overall between group effect for post-intervention (i.e. evaluation 2) POMS subscales was not significant (Wilks’ lambda F(6, 20) = 1.78, p < .16).
      Effects of intervention on psychological distress. It was hypothesized that meditation training would result in decreased scores on the psychological distress measure. An ANCOVA conducted to analyze the SCL-90-R GSI scores revealed a significant between group effect (F(1, 30) = 8.87, p < .006). Figure 5 displays the adjusted post-intervention (evaluation 2) mean GSI scores. Participants in the intervention group rated the severity of their psychological distress as significantly lower than participants in the wait list group.

Figure 5. Adjusted post-intervention (evaluation 2) mean SCL-90-R GSI scores.

      To examine if differences in psychological distress were evident on the subscales of the SCL-90-R, a MANCOVA was conducted. The overall between group effect for post-intervention (i.e. evaluation 2) SCL-90-R subscales was not significant (Wilks’ lambda F(9, 14) = 1.19, p < .38).

      To examine whether improvements in outcome were obtained in the wait list participants after they participated in the intervention phase of the study, a series of analyses were carried out. Change scores were computed for each outcome measure for the two phases of the study: (a) change over the wait list phase (computed by subtracting evaluation 2 data from evaluation 1 data), and (b) change over the intervention phase (computed by subtracting evaluation 3 data from evaluation 2 data). A series of one-sided t-tests was then conducted to compare the change scores obtained during the wait list and intervention phases of the study. Data from six participants who dropped out of the study between evaluations 2 and 3 were excluded in these analyses. In order to make sure that the participants who dropped out did not differ from the rest of the wait list group, t-test comparisons (or chi-square analyses, as appropriate) were performed comparing the dropouts with the rest of the wait list participants. Age, gender, handedness, initial (i.e. evaluation 1) values for overall pain and distress ratings, initial values for pain and distress ratings for the last half of trials, and initial CSI, TMD, and GSI scores were examined. No significant differences were found between the dropouts and the rest of the wait list participants on any of these variables.
      Table 3 shows the means and standard deviations for the wait list participants for changes in pain and distress ratings, Hassles Scale CSI scores, POMS TMD scores, and SCL-90-R GSI scores during the wait list and intervention phases of the study.

Table 3
Means and standard deviations for wait list participants for changes in scores during the wait list and intervention phases of the study

Effects of Intervention on Pain and Distress During the Laboratory Finger Pressure Pain Task
      Effects of intervention on distress ratings. A t-test comparing changes in overall mean distress ratings during the finger pressure pain task approached significance (t(1, 10) = 1.74, p < .057). Figure 6A presents the mean changes for both phases of the study. As can be seen, the means differed somewhat, with the wait list group showing greater decreases in overall distress ratings for the finger pressure pain task following the intervention versus wait list phases of the study.

Figure 6A. Changes in distress ratings for wait list participants during wait list and intervention phases of the study.

      A t-test comparing changes in distress ratings for the last half of the finger pressure pain task was found to be significant (t(1, 10) = 1.85, p < .047). Figure 6A presents the mean changes for both phases of the study. As can be seen, the means differed markedly, with the wait list group showing greater decreases in distress for the last half of the finger pressure pain task following the intervention versus wait list phases of the study.
      Effects of intervention on pain ratings. A t-test comparing changes in overall mean pain ratings during the finger pressure pain task was not significant (t(1, 10) = -.05, p < .53). Figure 6B presents the mean changes for both phases of the study. As can be seen, the means were very similar.

Figure 6B. Changes in pain ratings for wait list participants during wait list and intervention phases of the study.

      A t-test comparing changes in pain ratings for the last half of the finger pressure pain task was also not significant (t(1, 10) = .25, p < .41). Figure 6B presents the mean changes for both phases of the study. As can be seen, the mean decrease for the intervention phase was slightly larger than that for the wait list phase.

Coping Strategies Checklist
      Table 4 shows the changes in the number of wait list participants marking each item of the coping strategies checklist. As can be seen, there was an increase in the number of participants using sensory attention, and a slight decrease in the use of distraction and relaxation strategies. Chi-square analyses could not be conducted on these changes because of the low cell counts.

Table 4
Changes in the number of wait list participants marking each item of the coping strategies checklist

Intervention Compliance
      Participants in the wait list group performed the mindfulness meditation practice an average of 4.6 days (SD = .9) per week out of the recommended 7 days.

Effects of Intervention on Daily Hassles, Mood, and Psychological Distress
      Effects of intervention on daily hassles. A t-test comparing changes in Hassles Scale CSI scores approached significance (t(1, 10) = 1.72, p < .058). Figure 7 presents the mean changes for both phases of the study. As can be seen, the means differed somewhat, with the wait list group showing greater decreases in CSI scores following the intervention versus wait list phases of the study.

Figure 7. Changes in Hassles Scale CSI scores for wait list participants during wait list and intervention phases of the study.

      Effects of intervention on mood. A t-test comparing changes in POMS TMD scores was significant (t(1, 10) = 2.69, p < .012). Figure 8 presents the mean changes for both phases of the study. As can be seen, the means differed markedly, with the wait list group showing greater decreases in TMD scores following the intervention versus wait list phases of the study.

Figure 8. Changes in POMS TMD scores for wait list participants during wait list and intervention phases of the study.

      Effects of intervention on psychological distress. A t-test comparing changes in SCL-90-R GSI scores was not significant (t(1, 10) = 1.36, p < .11). Figure 9 presents the mean changes for both phases of the study. As can be seen, the means differed only slightly, but the differences were in the expected direction, with the wait list group showing greater decreases in GSI scores following the intervention versus wait list phases of the study.

Figure 9. Changes in SCL-90-R GSI scores for wait list participants during wait list and intervention phases of the study.

      The results of this study indicate that the intervention group showed decreased severity of daily hassles, improved mood, and decreased psychological distress following training in mindfulness meditation. During the intervention phase of the study, the wait list group also showed significant improvements in mood compared to the wait list phase. This group also showed decreased distress ratings during the last half of the finger pressure pain task following the intervention phase and nearly significant decreases in severity of daily hassles.
      The improvements in severity of daily hassles, mood, and psychological distress following meditation training are notable for two reasons. First, the intervention was not very intensive: a four-week mindfulness meditation training program consisting of weekly group sessions. In contrast, the SR&RP, which has served as a model for previous investigators, consists of a 10-week training program. Second, compliance with the daily mindfulness meditation practice was only moderate. On average, participants practiced only about four out of the seven recommended days per week. Nonetheless, participants exhibited substantial improvements in severity of daily hassles, mood, and psychological distress, suggesting that even a brief course of mindfulness meditation may be effective in modifying these outcomes. The outcomes obtained would probably be even more impressive if a more intensive intervention was used and if compliance with the meditation practice could be increased.
      The findings regarding mindfulness meditation training’s effectiveness in decreasing distress caused by painful stimuli were mixed. No significant effect was observed when comparing the intervention group’s distress ratings to the wait list group’s. However, after the wait list group was given the four-week intervention, they showed significant decreases in distress during the last half of the finger pressure pain task. They also showed nearly significant decreases in overall distress ratings during the finger pressure pain task following intervention. However, the results obtained from the wait list group must be interpreted cautiously because there were six dropouts from this group during the intervention phase. It is possible that the dropouts self-selected for some unknown reason and that those participants would not have exhibited comparable decreases in distress ratings. In addition, it is not possible to rule out that the observed decreases in distress ratings for the wait list group were due to the fact that they were exposed to the finger pressure pain task three times rather than two as in the intervention group. Perhaps with greater familiarity, the task was less distressing.
      There were several methodological issues encountered during the present study which may have contributed to the failure to find the expected decreases in distress during the finger pressure pain task for the intervention group. First, the weights used for the finger pressure pain task elicited unexpectedly low overall distress ratings. This appears to have created a floor effect, making it difficult to detect possible trends in the distress ratings. In future research, heavier weights should be used in order to elicit higher distress ratings and prevent such floor effects.
      Second, participants were not instructed to use the mindfulness meditation techniques during the finger pressure pain task. As the results of the coping strategies checklist show, participants did not increase their use of the sensory attention techniques which were taught in the mindfulness meditation intervention during the post-intervention finger pressure pain task. This made it difficult to determine if the lack of decrease in distress ratings was due to a problem with the mindfulness techniques themselves or due to the participants’ simply failing to use the techniques they had been taught. In future research, it would be helpful to examine the effect of instructing participants to use the mindfulness meditation intervention techniques during the finger pressure pain task. It would also be helpful to include more material during the intervention training specifically addressing the use of mindfulness as a coping strategy for acute pain.
      Third, participants in the study were only asked to meditate for 20 minutes daily. In the SR&RP, patients are asked to meditate for a minimum of 45 minutes per day. Since it was hypothesized that mindfulness’s success as a pain coping strategy would depend upon the ability of participants to maintain a stance of bare attention toward the sensations, it is possible that participants in the present study were not asked to practice enough during the intervention to develop the attentional control required to effectively use mindfulness as a pain coping strategy.
      Fourth, the visual analog scale used to measure distress during the finger pressure pain task may not have been effective in separating the sensory and affective components of the pain experience. Previous research has suggested that visual analog scales may be less able to discriminate between pain intensity and pain affect than other types of pain measures such as verbal rating scales (Duncan, Bushnell, & Lavigne, 1989). Because the distress scale used in the present study consisted of only one item, it may have failed to detect a wide spectrum of other possible affective responses to the finger pressure pain task. A multiple item pain measure such as the adjective checklist of the McGill Pain Questionnaire might have been more sensitive in measuring the affective component of participants’ pain perception.
      The present study was also limited by the reliance on a laboratory pain task instead of real-life pain. The results obtained would be more generalizable if a study was conducted examining how training in mindfulness meditation affects coping during exposure to pain encountered in the course of ordinary life. In addition, the current study focused solely on acute pain. Controlled research into the effects of mindfulness meditation on chronic pain coping would be helpful in gaining a clearer understanding of meditation’s mechanism of action and of its potential applications as a pain coping strategy.
      Although the present study yielded only mixed results regarding mindfulness meditation’s effectiveness in reducing distress caused by painful stimuli, the problems encountered in this pilot study should be useful for investigators conducting future research into the effects of mindfulness meditation on pain perception. Further, even if it were shown that, in fact, mindfulness meditation had no effect on pain perception, the results of the present study would still be potentially important to both normal individuals and pain patients. Even with a small number of participants, the present study demonstrated that a brief mindfulness meditation training program can produce significant improvements in perceptions of daily hassles, mood, and psychological distress. Because all people are subject to daily hassles, negative moods, and psychological distress, mindfulness meditation has widespread potential applications. This is especially true of chronic pain patients, for whom physicians are often unable to treat the underlying cause of their pain effectively and must instead attempt to lessen their patients’ suffering by improving their quality of life. Mindfulness meditation could be a useful self-management tool in such cases to help reduce patients’ psychological suffering.

      ¹ Mindfulness meditation, insight meditation, and awareness meditation are alternate translations of the same Sanskrit term, vipassana.
      ² In Buddhist psychology there are six senses (sight, smell, touch, taste, hearing, and mind), the objects of which together comprise all of an individual’s experience.
      ³ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts.
      ⁴ Prior investigators had metal weights custom smithed at great expense in order to make them visually identical. In the present study, plastic vials were coated with black paint and filled with varying amounts of sand to achieve the same result at a considerable cost savings.
      ⁵ Decreased n at evaluation 2 because one participant’s questionnaire was missing. At evaluation 1, this participant did not mark any items.

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      Brian T. Hafer, Department of Psychology, Duke University.
      I thank Dr. Francis J. Keefe for assistance in designing the experiment, for reading the manuscript, and for guidance in making revisions. I thank Dr. Katherine Wright for assistance in leading the meditation training sessions and in analyzing the data obtained. I also thank all those who kindly volunteered to participate in the study. This study was conducted in partial fulfillment of the Latin honors thesis requirements of the Department of Psychology.