Co-emergence Reinforcement and its Relevance to Interoceptive Desensitization in Mindfulness and Therapies Aiming at Transdiagnostic Efficacy.

Interoception, the ability to feel the body’s internal sensations, is an essential aspect of emotional experience. There is mounting evidence that interoception is impaired in common mental health disorders and that poor interoceptive awareness is a major contributor to emotional reactivity, calling for clinical interventions to address this deficit. The manuscript presents a comprehensive theoretical review, drawing on multidisciplinary findings to propose a metatheory of reinforcement mechanisms applicable across a wide range of disorders. We present a reconsideration of operant conditioning through the co-emergence model of reinforcement, which is a neurophenomenological account of the interaction between cognition and interoception, and its consequences on behavior. The model suggests that during memory processing, the retrieval of autobiographical memory (including maladaptive cognition) is dependent upon its co-emerging interoceptive cues occurring at the encoding, consolidation and reconsolidation stages. Accordingly, “interoceptive reinforcement” during emotional distress is a common factor to all emotional disorders and a major cause for relapse. We propose that interoceptive desensitization has transdiagnostic benefits, readily achievable through the cultivation of equanimity during mindfulness training and can be integrated in cognitive and behavioral interventions to permit a transdiagnostic applicability. We summarize the contributions of this approach into 10 specific and testable propositions

Immediate and Lasting Chronic Pain Reduction Following a Brief Self-Implemented Mindfulness-Based Interoceptive Exposure Task: a Pilot Study

Abstract Recent imaging research shows that approximately 80%ofpeoplewhotransitfromacutetochronicpainproduce neuroplasticity linking pain pathways to learning areas of the brain, thus showing physiological evidence that chronic pain is largely learned. Mindfulness meditation programs have been used successfully to teach people a way of decreasing pain-related distress and unlearning their unhelpful relationship to pain. However, not all chronic pain patients are amenable to undergo a full mindfulness program and then maintaindailypractice.Accordingly,weconductedapilotstudyof a task extracted from a second-generation MBI, Mindfulnessintegrated Cognitive Behavior Therapy, which consisted of a self-guided 30-s mindfulness-based interoceptive exposure task (MIET) to pain sensations in 15 medically diagnosed chronic pain patients. Participants using the MIET repeatedly over 15 days learned not to identify with pain and focused on four subcomponents of interoception (mass, motion, temperature, and cohesiveness) while remaining equanimous. This ledtosignificantreductioninpainanxiety(p=.001;d=0.96), pain duration (p = .01;d = 0.86), and pain intensity after each 30-s exposure (p < .001;d = 1.37). These effects were maintained, and some further improved, at 2-month follow-up. Marked decrease in depression, anxiety and stress were also observed(p<.001;d=0.81).Whileparticipantsratedthetask as highly acceptable and some reduced their use of analgesic medication; no other change in medical or psychological treatment was required. These early results show the potential for the MIET to be use as an adjunct to traditional treatments of chronic pain, although controlled studies are needed to establish the validity of our results. Brain-imaging studies are also needed to assess the possible unlearning effect of the MIET on corticolimbic regions, a process that may be termed Bcentral desensitization.

Development and Validation of the Equanimity Scale-16

Abstract Objectives Equanimity is a non-reactive attitude that is increasingly recognized as a central component of mindfulness practice and a key mechanism of mindfulness-based interventions that is currently lacking means of measurement. The present study aimed to develop a self-report measure of equanimity, explore its underlying factor structure, validity and reliability. Methods An initial pool of 42 items was selected from existing mindfulness questionnaires and measures of related constructs, and subsequently reviewed by researchers and selected based on majority agreement on their construct validity. The Qualtrics online platform was used to administer these items and other questionnaires used to assess validity and collect demographic information in 223 adults from the general community (66.8% females and 33.2% males, age range = 18–75). Questionnaires were then re-administered to assess test-retest reliability. Results In agreement with past research, exploratory factor analysis revealed two underlying factors, Experiential Acceptance and Non-reactivity. A final 16-itemmeasure showed good internal consistency (⍺ = .88), test-retest reliability (n = 73; r = .87, p < .001) over 2–6 weeks and convergent and divergent validity, illustrated by significant correlations in the expected direction with the Nonattachment Scale, Depression Anxiety and Stress Scale, Satisfaction with Life Scale and Distress Tolerance Scale. Conclusions Based on this initial study, the Equanimity Scale-16 appears to be a valid and reliable self-report measure to assess trait equanimity, and may be further explored in future studies as a tool to assess progress during mindfulness-based interventions, and to assist in the investigation of their underlying mechanisms

Traditional and Contemporary Mindfulness: Finding the Middle Path in the Tangle of Concerns

Contemporary mindfulness has grown through innumerable secular and clinical programs. This rapid growth has raised two main concerns from the Buddhist community: the accuracy of the teachings and the impact of not explicitly including ethics as part of the teachings. Specific concerns include a potential weakening of the concept of right mindfulness and, as a corollary, misunderstanding the intent mindfulness as being a technique for symptomatic relief. With respect to the absence of explicit ethics in the teachings, concerns are expressed that this omission risks misappropriating mindfulness practices so that they do more harm than good. This article explores the main criticisms expressed by Traditional Mindfulness community and assesses the validity of these criticisms. The dialogue between traditional and contemporary mindfulness practitioners is an opportunity to examine the conceptual integrity of mindfulness-based interventions (MBIs) with respect to what comprises right mindfulness, assess whether MBIs include the factors that can extend them beyond symptomatic relief, and reflect on the issues related to teaching ethics as part of an MBI program. Because ethics is viewed in Traditional Mindfulness as a foundation for a meditative practice, it is explored in detail for its potential contribution to MBIs