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Psychoneuroendocrinology

journal homepage:www.elsevier.com/locate/psyneuen Acceptance lowersstress reactivity:Dismantling mindfulnesstraining ina randomized controlledtrial

Emily K.Lindsay

a ,
, ShinzenYoung b , JoshuaM. Smyth c , KirkWarren Brown d, J.David Creswell a a

Carnegie MellonUniversity, UnitedStates

b

University ofVermont, UnitedStates

c

Pennsylvania StateUniversity, UnitedStates

d

Virginia CommonwealthUniversity, UnitedStates

ARTICLE INFO

Keywords:

Mindfulness

Acceptance

Attention

Stress reactivity

Mechanisms

Stress biology

ABSTRACT

Objective:Mindfulness interventions,which trainpractitioners tomonitortheir present-momentexperience with

a lensof acceptance, areknown tobu
er stressreactivity. Littleis knownabout theactive mechanismsdriving

these e
ects. Wetheorize thatacceptance isa criticalemotion regulationmechanism underlyingmindfulness stress reductione
ects. Method:In thisthree-arm paralleltrial, mindfulnesscomponents weredismantled intothree structurally

equivalent 15-lessonsmartphone-based interventions:(1) trainingin bothmonitoring andacceptance (Monitor

+ Accept),(2) trainingin monitoringonly (MonitorOnly), or(3) activecontrol training(Coping control).153

stressed adults(mean age= 32years; 67%female; 53%white, 21.5%black, 21.5%Asian, 4%other race)were

randomly assignedto completeone ofthree interventions.After theintervention, cortisol,blood pressure,and

subjective stressreactivity wereassessed usinga modied TrierSocial StressTest.

Results:As predicted,Monitor +Accept trainingreduced cortisoland systolicblood pressurereactivity com-

pared toMonitor Onlyand controltrainings. Participantsin allthree conditionsreported moderatelevels of

subjective stress.

Conclusions:This studyprovides therst experimentalevidence thatbrief smartphonemindfulness trainingcan

impact stressbiology, andthat acceptancetraining drivesthese e
ects. Wediscuss implicationsfor basicand

applied researchin contemplativescience, emotionregulation, stressand coping,health, andclinical inter-

ventions.1. Introduction Mindfulness meditationtraining hasemerged asa leadingstress reduction approachin recentyears (Creswell andLindsay, 2014 ). For example, eight-weekmindfulness interventionshave beenshown to reduce physiologicaland subjectivereactivity toacute stresschallenge tasks (Britton etal., 2012;Hoge etal., 2013;Nyklí
ek etal., 2013). Still, little isknown aboutthe activemechanisms ofmindfulness interven- tions thatdrive thesestress reductione
ects. Mindfulnesstraining commonly involvesusing attentionto monitorpresent-moment experi- ence whilefostering acceptanceof one"s currentstate (Bishop etal.,

2004). Onepossibility isthat acceptance-dened asan orientationof

noninterference andopenness towardmomentary sensoryexperience (i.e., thoughts,emotions, bodysensations, sights,and sounds)-is a critical emotionregulation mechanism( Hölzel etal., 2011) underlying

mindfulness trainingstress reductione
ects (Lindsay andCreswell, 2017). Incontrast toavoiding, altering,or focusingnarrowly onsalient

negative stimuli,acceptance isan attitudeof receptivityand equani- mity towardall momentaryexperiences thatallows evenstressful sti- muli toarise andpass withoutreactivity. Self-reportedacceptance skills are associatedwith lowerphysiological andneural stressreactivity (Paul etal., 2013;Shallcross etal., 2013), andemotional acceptanceis an e
ective strategyfor regulatingnegative a
ect (Kohl etal., 2012) that maydampen physiologicalreactivity toemotional stimuli( Dan- Glauser andGross, 2015). Toevaluate theimportance ofacceptance training asa stressreduction mechanismin mindfulnessinterventions, we reportthe resultsof therst three-armrandomized controlleddis- mantling trialthat comparesa fullmindfulness trainingprogram (Monitor +Accept) toa mindfulnesstraining programwithout accep- tance instructions(Monitor Only)and anactive placebocontrolled program (Copingcontrol).

Although thereare nowmultiple evidence-basedin-person http://dx.doi.org/10.1016/j.psyneuen.2017.09.015

Received 1May 2017;Received inrevised form13 September2017; Accepted14 September2017

Corresponding authorat: CarnegieMellon University,Department ofPsychology, 342CBaker Hall,5000 ForbesAvenue, Pittsburgh,PA 15213,United States.

E-mail address:elindsay@andrew.cmu.edu(E.K. Lindsay).