Measuring Mindfulness: Choosing the Right Assessment for Your Practice

Although by no means a novel practice, mindfulness has quickly become a hot topic in conversations about mental health. Evidence that mindfulness training can reduce symptoms and improve quality of life abounds, but the task of quantifying that improvement is less straightforward. The ability to measure mindfulness accurately and reliably is critically important in order to align these alternative treatment approaches with outcome-based initiatives that are quickly becoming the norm across health systems. In this regard, measures of mindfulness will allow clinicians to practice measurement-based care while doing so in a non-pathologizing fashion.

So…where can you start?

While there are a number of instruments for measuring mindfulness, some are better than others. A systematic review analyzed 46 studies of measurement instruments, evaluating for six properties in the COSMIN taxonomy: internal consistency, reliability, content validity, structural validity, hypothesis testing and responsiveness. The following instruments were identified through the study as having moderate or strong positive results for two or more properties. Each is briefly summarized below and may play unique roles in the process of treatment across a range of care settings.

Mindfulness Attention Awareness Scale (MAAS)
The first widely-disseminated tool of its kind, MAAS is a 15item assessment that operationalizes mindfulness as a single construct - a “present-centered attention-awareness in everyday experience” that is state, trait, and skill. This instrument is intended as a generic measure appropriate regardless of meditation experience. Notably, the MAAS was evaluated by the most studies and had positive overall quality ratings for most of the psychometric properties reviewed.

Kentucky Inventory of Mindfulness Skills (KIMS)
KIMS assesses the tendency toward mindfulness in areas of daily life related to skills taught in mindfulness interventions, particularly Dialectical Behavior Therapy. The inventory consists of 39 items grouped into four subscales: Observe, Describe, Act with awareness, and Accept without judgement.

Cognitive and Affective Mindfulness Scale-Revised (CAMS-R)
Designed as a generic measure appropriate regardless of meditation experience, CAMS-R is a 12-item measure intended to be a succinct, simple, and conceptually comprehensive tool. Mindfulness is understood as comprised of four aspects: attention, present-focus, awareness, and acceptance/non-judgment.

Five Facet Mindfulness Questionnaire (FFMQ)
The FFMQ is a 39-item measure developed from factor analysis of the previous five tools (MAAS, KIMS, FMI, CAMS-R, and SMQ). As its name suggests, questionnaire has five facets: Observing, Describing, Acting with Awareness, Nonjudging of inner experience, and Nonreactivity to inner experience. The FFMQ received the highest possible rating for internal consistency and construct validation by hypothesis testing.

Toronto Mindfulness Scale (TMS)
The original TMS is a 13-item, two-factor structure that assesses mindfulness as a state, rather than trait. Administration consists of a brief mindfulness exercise that is immediately followed by self-administration of the instrument, and the scale’s items assess the quality of that experience. The TMS has two distinct subscales - Curiosity and Decentering - and a total score is not reported.

Experiences Questionnaire (EQ)
The EQ measures decentering - a major outcome of mindfulness-based cognitive therapy that fosters resilience to/against depressive thoughts. This 20-item measure is particularly well-suited for working with populations with high levels of depression or who are at risk for relapse.

Philadelphia Mindfulness Scale (PHLMS)
PHLMS assesses mindfulness operationalized as Awareness (a behavioral tendency to continually monitoring internal and external experience as it occurs) and Acceptance (a nonjudgmental, nonreactive stance towards those experiences). Although applicable to many treatment settings, this 20-item measure is commonly used in conjunction with Acceptance and Commitment Therapy (ACT).

While the above measures may be preferred on psychometric grounds over other instruments, both providers and patients are likely to benefit most from measures that are easily integrated into treatment. Clinicians need to be able to trust that their assessments work, but it is just as important that patients actually use the assessments - and do so consistently.  Each treatment setting or type of provider may benefit from something a little different. Understanding the differences across the measures empowers providers to choose the ones that most suited their unique practices.

Park, T., Reilly-Spong, M., & Gross, C. R. (2013). Mindfulness: A systematic review of instruments to measure an emergent patientreported outcome (PRO). Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 22(10).

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