ORIGINAL RESEARCH
COMPARING BRIEF STRESS MANAGEMENT COURSES IN A COMMUNITY SAMPLE:
MINDFULNESS SKILLS AND PROGRESSIVE MUSCLE RELAXATION
John D. Agee, PhD,1# Sharon Danoff-Burg, PhD,2 and Christoffer A. Grant, MA2
This study sought to compare a five-week mindfulness medi-
tation (MM) course to a five-week course that taught progressive
muscle relaxation (PMR). Forty-three adults from the commu-
nity were randomly assigned to either MM (n ⫽ 19) or PMR
(n ⫽ 24) courses after responding to flyers and other advertise-
ments for a free stress management course. Mindfulness medi-
tation participants practiced meditation significantly more often
than PMR participants practiced relaxation during the interven-
tion period (F[1, 43] ⫽ 7.42; P ⬍ .05). Interestingly, the two
conditions did not differ significantly in their posttreatment
levels of relaxation or mindfulness. Although there were no
INTRODUCTION
The word stress, as used colloquially, typically refers to the sub-
jective sense of being overwhelmed with many different de-
mands. Although these demands do not always have true tem-
poral overlap from one moment to the next, our minds make it
feel as though they do. Therein lies the intuitive application of
the practice of mindfulness as a means of stress management.
Mindfulness may be defined as an intentional awareness of our
present-moment experience in a direct and accepting way, reori-
enting ourselves to reality when our internal experiences— or our
attempts to avoid them— begin to distract our attention from the
real demands of our current situation. In practicing mindfulness
then, we can become more aware of the mind’s tendency to
focus on mental representations of things in our lives that are
beyond our immediate control, and we can learn to relate more
dispassionately to any number of potentially stressful experi-
ences. Perhaps not surprisingly, in the past three decades mind-
fulness skills training has been increasingly incorporated in a
variety of methods of psychotherapy and stress management,
with growing empirical support for its use.1,2
Despite promising findings from research examining inter-
ventions incorporating mindfulness skills, one significant gap in
the existing literature is the dearth of published studies compar-
ing mindfulness-based interventions,3 such as mindfulness-
based stress reduction (MBSR),4 with other empirically sup-
ported stress management interventions. With regard to stress
management research, only very recently has this issue begun to
be addressed. Jain and colleagues5 published the results of a
1 Mental Health Service, Togus VA Medical Center, Augusta, ME
2 Department of Psychology, University at Albany, State University of
New York, Albany, NY
# Corresponding Author. Address:
e-mail: john.agee@med.va.gov
104 Published by Elsevier Inc.
ISSN 1550-8307/09/$36.00
differences between groups on any of the primary outcome mea-
sures, across both treatment conditions there were statistically
significant reductions from pretreatment to posttreatment in
general psychological distress. Thus, although MM did not
emerge as clearly superior to PMR, results of this study suggest
that a brief mindfulness skills course may be effective for stress
management.
Key words: Mindfulness, stress management, meditation, mus-
cle relaxation
(Explore 2009; 5:104-109. Published by Elsevier Inc.)
randomized controlled trial in which a wait-list control condi-
tion was compared with a mindfulness meditation (MM) inter-
vention and a “somatic relaxation training” intervention that
taught both progressive muscle relaxation (PMR) and diaphrag-
matic breathing. Compared with the control condition, both
treatment conditions experienced significant reductions in psy-
chological distress, as well as significant increases in positive
states of mind.5 In addition, these authors found that MM may
differ from relaxation in its potential for reducing rumination
and distraction.5
The primary aim of the present study was to compare a five-week
MM intervention to an established stress management technique—
training in PMR—among a sample of nonclinical adults recruited
from the community. A briefer mindfulness intervention was
planned given that the intensive time commitment required by
traditional MBSR programs was not likely to appeal to our popu-
lation of interest—individuals in the community with many existing
time commitments and other demands. Previous research6 has
demonstrated that even a four-week mindfulness intervention may
be effective for stress management, such that we felt confident in
selecting five weeks as the time frame for this study. Progressive
muscle relaxation was chosen as a comparison intervention due to
its wide acceptance and use by health professionals, in addition to
the research literature supporting its use.7 Based on existing research
comparing meditation with relaxation,5,8 we hypothesized that fol-
lowing treatment, MM participants would experience reductions in
psychological distress that were at least comparable to those in the
PMR condition. Based on the nature of each intervention, we hy-
pothesized that following treatment, MM participants would dem-
onstrate greater levels of mindfulness than those in the PMR con-
dition, and hypothesized that PMR participants would
demonstrate higher levels of physical relaxation than MM partici-
pants. Concerning reported frequency of at-home skills practice, no
between-group differences were expected. In terms of participants’
ratings of each intervention, the MM intervention was hypothe-
EXPLORE March/April 2009, Vol. 5, No. 2
doi:10.1016/j.explore.2008.12.004
sized to be rated as at least as effective and satisfying as the PMR
intervention.
METHOD
Participants
Recruitment for this study targeted both the university commu-
nity and the community at large by using a combination of
flyers, print media advertisements, and postings to online com-
munity events calendars. Seventy-six individuals recruited from
the community initially expressed interest in participation. Two
potential participants were screened out due to meeting exclu-
sion criteria (current or recent psychosis or suicidal ideation) and
were referred to appropriate community mental health re-
sources. Twenty of those who initially expressed interest either
failed to return correspondence or indicated that they did not
have enough time to participate. Eleven potential participants
completed the informed consent procedure and baseline ques-
tionnaires but failed to attend any of the stress management
group sessions. The resultant sample (N ⫽ 43) consisted of 19
participants in the MBSR condition and 24 in the PMR condi-
tion.
Participants ranged in age from 18 to 71 years (mean ⫽ 41.63,
SD ⫽ 13.04). Thirty-nine (90.7%) were women and four (9.3%)
were men. Participants self-described their racial/ethnic back-
grounds as follows: Caucasian or European American (74.4%),
African American (2.3%), Asian (2.3%), Hispanic (2.3%), and
Native American (2.3%). Another 16.3% of participants chose
not to report their ethnicity. Most participants (81.4%) were
employed full-time, whereas fewer reported working part-time
(16.3%) or being full-time students (2.3%). Most participants
were well educated, with 74.5% of the sample reporting having
earned a bachelor’s degree or graduate degree, and another
23.2% reporting having completed at least some college educa-
tion. Only one participant in the final sample of 43 had high
school as the highest level of education. Thus, the average par-
ticipant in the present study was a Caucasian woman in her early
40s who was college educated and employed full time.
Procedure
The study was reviewed, approved, and conducted in accor-
dance with the university’s institutional review board. Recruit-
ment for this study targeted both the university community and
the community at large by using a combination of flyers, print
media advertisements, and postings to online community event
calendars. The study was described as “a free stress management
course” in which “stress reduction methods like progressive re-
laxation and meditation” would be taught. The advertisements
encouraged interested individuals to call for more information,
and upon initial contact by telephone, potential participants
were screened for appropriateness based on the following rule-
out criteria: no current or recent (within 1 month) suicidality or
psychosis. Ineligible participants based on these criteria were
given appropriate community mental health referrals. Those
deemed eligible were mailed informed consent forms and base-
line questionnaires. Participants who completed the informed
consent process and returned baseline questionnaires were then
randomly assigned to either the MM condition (n ⫽ 19) or the
PMR condition (n ⫽ 24).
Comparing Brief Stress Management Courses
Each intervention was conducted in a small group format.
Groups met for one hourly session each week, for a total of five
weeks. Participants in both treatment conditions were given the
same basic overview of the effects of stress and anxiety by using
the fight-or-flight response as a model to illustrate the nature of
cognitive, behavioral, and physiological responses to perceived
threats or stressors. Over the course of treatment, those in the
PMR condition were first taught a 16 muscle group version of
PMR, an eight muscle group version, then a 4 muscle group
version, and finally, recall relaxation. At each MM session, par-
ticipants were engaged in five minutes of gentle stretching exer-
cises and seated MM adapted from Kabat-Zinn’s MBSR pro-
gram.4 Seated meditation periods increased incrementally in
duration as treatment progressed, from 15 minutes at session one
to 45 minutes by session five.
Participants in both treatment conditions were given audio
recordings to guide their at-home practice of seated MM or
PMR. They were encouraged to practice twice daily for 15 min-
utes or more and were asked to keep records of their daily relax-
ation or meditation practice. For missed sessions, brief (10-20
minutes) makeup sessions were offered individually either via
telephone or immediately prior to the next session. Following
completion of each intervention, participants completed
postintervention questionnaires, as well as evaluations of the
treatment similar to the treatment expectancies questionnaire
they completed before each intervention began. Attempts were
made to contact by telephone or postal mail participants who
dropped out of the study so that their reasons for discontinuing
could be noted.
Therapists
Therapists for the present study were four advanced doctoral
students in clinical psychology—two men and two women. The
first author (JDA) was the primary therapist for the majority of
the intervention groups and had previous experience with stress
management interventions and MM, including approximately
six years of personal meditation experience at the time the study
was conducted. All three of the other therapists were trained in
delivering both interventions (MM and PMR) used in this study,
through a combination of individual training and consultation,
as well as modeling during group sessions. Two therapists con-
ducted each group session, and over the course of the study,
therapists were counterbalanced between the MM and PMR
interventions to help control for any therapist effects. No formal
assessments (eg, third-party ratings of videotaped sessions) were
made of therapists’ adherence to the intervention protocols.
Materials
Depending on the treatment condition to which they were as-
signed, participants were given audio recordings of either PMR
or MM exercises to guide their home practice of these stress
management techniques. The PMR instructions were adapted
from standardized relaxation training procedures9 and included
recordings of 16 muscle group, eight muscle group, and 4 muscle
group relaxation, as well as recall relaxation. The MM instruc-
tions asked listeners to mindfully observe each new breath in the
moment and to count their breaths from one to 10 to help them
stay focused on each new breath. For standardization purposes,
EXPLORE March/April 2009, Vol. 5, No. 2 105
both sets of audio recordings were recorded using the same
narrator’s voice, as well as the same instrumental music played at
a very low volume in the background.
Measures
Demographic information. Demographic information col-
lected at baseline included gender, age, employment status, level
of education, and ethnicity.
Pretreatment expectations. Immediately prior to beginning
treatment, participants were asked to respond to three items
adapted from an established measure of treatment expectan-
cies,10 inquiring about their expectations for the intervention to
help them manage stress more effectively. As each item was
scored on a five-point, Likert-type scale, a summary score for
each participant’s overall pretreatment expectancy was created
by simply adding together the individual item scores for the
three items.
Practice records. During the course of each five-week interven-
tion, participants were asked to record on a work sheet the fre-
quency of their practice of the stress reduction methods they
learned (either PMR or MM) and their levels of relaxation before
and after each practice session, scoring with a five-point, Likert-
type scale.
Posttreatment evaluation. Immediately following treatment,
participants rated the intervention they completed in terms of
their satisfaction with the treatment, as well as its effectiveness in
helping them manage stress. These items were designed to par-
allel the pretreatment expectancy items.
Mindfulness. The Mindful Attention and Awareness Scale
(MAAS)11 was used to measure participants’ levels of mindful-
ness. The MAAS is a 15-item measure of mindfulness, with all
items loading on a single factor. Each item is rated on a six-point,
Likert-type scale, ranging from “almost always” to “almost
never.” For instance, one MAAS item is, “I find it difficult to stay
focused on what’s happening in the present.” Since the scale has
a single factor, the MAAS is simply scored by calculating a mean
score across all items, such that total scores range from one (least
mindful) to six (most mindful). The MAAS has satisfactory in-
ternal reliability, with alphas ranging from .82 to .87, and test-
retest reliability (r ⫽ 0.81).11 Observed internal consistency reli-
abilities for the MAAS in this study ranged from .78 to .90. The
MAAS was administered at pretreatment and posttreatment.
Psychological distress. The Brief Symptom Inventory (BSI)12 is
a 53-item self-report measure of psychological symptoms. The
BSI yields nine primary symptom dimensions (somatization,
obsessive-compulsive, interpersonal sensitivity, depression, anx-
iety, hostility, phobic anxiety, paranoid ideation, and psychoti-
cism) and three global distress indices (general severity index,
positive symptom distress index, and positive symptom total).
106 EXPLORE March/April 2009, Vol. 5, No. 2
Respondents rate each BSI item on a five-point scale, ranging
from “not at all” to “extremely” with regard to how much that
symptom has distressed or bothered them during the past week.
A sample item from the BSI is, “Feeling hopeless about the
future.” The BSI has demonstrated adequate reliability and va-
lidity, with internal consistency reported to range from .71 to .85
and test-retest reliability coefficients reported to range from .68
to .91.12 Observed internal consistency reliabilities for the BSI in
this study ranged from .89 to .95.
In line with previous mindfulness research,13,14 the BSI gen-
eral severity index was used as a global measure of psychological
distress for the purposes of the present study. Normative mean
scores for the BSI general severity index have been reported to
range from 0.30 (SD ⫽ 0.31) in nonpatients to 1.32 (SD ⫽ 0.72)
in psychiatric outpatients. 12 The BSI was administered at pre-
treatment and posttreatment.
Relaxation. The Behavioral Relaxation Scale (BRS)15 was used
as an objective assessment of participants’ levels of relaxation
during in-session practice of relaxation or meditation. The BRS
assesses 10 dimensions of relaxation with a structured behavioral
observation protocol and includes breathing, quietness, body,
head, eyes, mouth, throat, shoulders, hands, and feet. For exam-
ple, for the hands, relaxation is judged by noting that hands are
unclenched, “with palms down and fingers slightly curled.” Ac-
cording to the BRS protocol, participants were rated by one of
the group therapists during in-session skills practice as either
“relaxed” or “unrelaxed” on each of the 10 dimensions measured
by the BRS.
RESULTS
Participants
An independent samples t test found that there were no signifi-
cant between-group differences for any of the pretreatment ex-
pectations items: expected degree of stress reduction (t[41] ⫽
1.61; P ⫽ .17), confidence in the treatment (t[41] ⫽ 1.16; P ⫽
.25), or level of skills mastery expected to be obtained through
participation (t[41] ⫽ 1.28; P ⫽ .21). A one-way (MM vs PMR)
multivariate analysis of variance (MANOVA) was used to test for
significant between-group differences on the primary outcome
measures administered prior to treatment (BSI general severity
index and MAAS). No significant between-group differences
Table 1. Outcome Measures by Time and Condition
Treatment Condition
MBSR PMR
Outcome Measure Time Point Mean (SD) Mean (SD)
BSI GSI Pretreatment 0.83 (0.54) 0.61 (0.28)
Posttreatment 0.60 (0.51) 0.43 (0.26)
MAAS Pretreatment 3.50 (0.83) 3.58 (0.85)
Posttreatment 3.84 (0.65) 3.98 (0.59)
MBSR, mindfulness-based stress reduction; PMR, progressive muscle relax-
ation; BSI GSI, Brief Symptom Inventory general severity index; MAAS, Mindful
Attention and Awareness Scale.
Comparing Brief Stress Management Courses
were found on any of these outcome measures at baseline (F[1,
40] ⫽ 0.41; P ⫽ .89). See Table 1 for scores on these outcome
measures by treatment condition at pretreatment and posttreat-
ment.
Thirty-six participants (83.7%) who began treatment went on
to complete the study, defined by attendance of at least four of
five of the stress management intervention sessions, and all but
one of those participants completed the postintervention ques-
tionnaire. The completion rates were 94.7% for the MM condi-
tion and 75% for the PMR condition. Although scant data exist
to describe rates of completion for PMR interventions, the rate
of completion for the MM intervention in this study was found
to be comparable to statistics reported in research on MBSR.11
Although a higher number of participants in the PMR condition
dropped out after beginning treatment compared with the MM
condition, a chi-square analysis found that this difference in
attrition was not statistically significant (␹2[1, 43] ⫽ 3.03; P ⫽
.08). Of the seven total (16.3%) participants who dropped out
after beginning treatment, those who returned correspondence
cited not having enough time to continue their participation as
their primary reason for discontinuing. A point biserial correlation
found that pretreatment expectation ratings were not significantly
correlated with discontinued participation (r ⫽ 0.04; P ⫽ .80).
Mindfulness
A one-way analysis of covariance (ANCOVA; MM vs PMR) was
used to test the hypothesis that participants in the MM condi-
tion would demonstrate greater posttreatment levels of mindful-
ness than those in the PMR condition, with pretreatment MAAS
scores as a covariate, and posttreatment MAAS scores as the de-
pendent variable. A preliminary analysis evaluating the homogene-
ity of slopes assumption indicated that the relationship between the
covariate and MAAS scores at posttreatment, one-month follow-
up, and three-month follow-up did not significantly differ as a
function of group assignment. Results of the ANCOVA indicated
that there were no statistically significant between-group differences
in MAAS scores posttreatment (F[1, 35] ⫽ 1.15; P ⫽ .29). One-way
ANCOVAs were also used to examine between-group differences
in MAAS scores at one-month and three-month follow-up points,
also using pretreatment MAAS scores as a covariate. However, no
significant differences in MAAS scores between the MM and PMR
conditions were found at one month (F[1, 28] ⫽ 0.09; P ⫽ .77) or
at three months posttreatment (F[1, 18] ⫽ 0.14; P ⫽ .71). Mean
MAAS scores at all assessment points were at or above the scale’s
midpoint. A repeated measures ANOVA was used to test for within-
⫹subjects changes in MAAS scores from pretreatment to posttreat-
ment for both conditions. The results of this analysis indicated that
for both treatment conditions, changes in MAAS scores were not
statistically significant (F[1, 35] ⫽ 3.84; P ⫽ .06).
Psychological Distress
To compare the effectiveness of the two interventions (MM and
PMR) in psychological distress from pretreatment to posttreat-
ment, a one-way (MM vs PMR) ANCOVA was conducted using
each participant’s pretreatment BSI general severity index score
as a covariate. A preliminary analysis evaluating the homogene-
ity of slopes assumption indicated that the relationship between
the covariate and dependent variable did not significantly differ
Comparing Brief Stress Management Courses
as a function of group assignment. Although both treatment
groups experienced reductions in BSI general severity index
scores, the difference between groups was not statistically signif-
icant (F[1, 35] ⫽ 0.02; P ⫽ .88).
In the absence of between-group differences in reductions in
psychological distress, a repeated measures ANOVA was used to
test for within-subjects change from pretreatment to posttreat-
ment for both conditions. Thus, although no significant be-
tween-group differences emerged, participants in both treatment
conditions did experience statistically significant reductions in
general psychological distress (F[1, 35] ⫽ 13.39; P ⫽ .001).
Based on these observed reductions in distress across both treat-
ment conditions, in the absence of significant between-group
differences, data from both intervention groups were pooled to
examine overall effect sizes demonstrated by both treatments in
terms of decreasing stress. A paired-samples t test was used to
examine differences between pretreatment and posttreatment
BSI general severity index scores and found reductions in psy-
chological distress across the combined sample. Effect size anal-
yses indicated a medium-sized effect for treatment in reductions
on the BSI general severity index (Cohen’s d ⫽ 0.63).
Relaxation
Although it was expected that participants in both treatment
conditions would experience relaxation over the course of treat-
ment, it was hypothesized that PMR participants would demon-
strate greater levels of relaxation than those in the MM condi-
tion. This hypothesis was tested using a one-way ANOVA (MM
vs PMR) for observed levels of relaxation by using a BRS sum-
mary score as the dependent variable. Behavioral Relaxation
Scale scores were calculated for each participant every session as
a ratio ranging from zero to one, with relaxation on all 10 di-
mensions measured yielding a ratio of one; BRS summary scores
were calculated as a mean of the BRS scores of each participant
for the entire five-week intervention period by using the number
of sessions attended as the denominator in the equation.
Whereas mean BRS ratings for the PMR condition (mean ⫽ 71,
SD ⫽ 0.22) were slightly higher than for MM participants (mean ⫽
0.63, SD ⫽ 0.14), this difference was not found to be signifi-
cantly different (F[1, 38] ⫽ 1.29; P ⫽ .26). Given that BRS scores
in the present study were calculated as a ratio ranging from zero
to one, participants in both conditions were observed to have
attained moderate levels of relaxation while engaging in skills
practice—MM and PMR.
Skills Practice Adherence and Outcomes
Data were collected from participants in both treatment condi-
tions in terms of their frequency of skills practice (either MM or
PMR) during the intervention. It was expected that MM partic-
ipants would report practicing stress management skills at least
as often as PMR participants. This hypothesis was examined
using a one-way (MM vs PMR) ANOVA, with frequency of
at-home practice as the dependent variable. The number of par-
ticipants self-reported, at-home practice sessions for the five-
week intervention period were totaled, such that an overall sum
of practice sessions was calculated for each participant. Consis-
tent with what was hypothesized, participants in the MM con-
dition reported practicing MM on their own significantly more
EXPLORE March/April 2009, Vol. 5, No. 2 107
often than those in the PMR condition reported at-home prac- Participant Evaluations of the Interventions
tice of their relaxation skills (F[1, 43] ⫽ 7.42; P ⬍ .05). Partici- A one-way (MM vs PMR) MANOVA was used to test for be-
pants in both interventions (MM and PMR) were instructed to tween-group differences in participants posttreatment evalua-
practice meditation or relaxation twice daily for the four weeks tions of the interventions in which they participated. Dependent
between the five intervention sessions. A repeated measures variables for this MANOVA included participants subjective,
ANOVA was used to examine rates of skills practice over time Likert-scale ratings of the intervention in which they participated
during both interventions. Although the results of this ANOVA in terms of (a) the degree of stress reduction they felt, (b) the level
indicated that there was not a significant interaction for Time ⫻ of mastery of the specific stress-management skills they learned,
Condition (F[3, 43] ⫽ 0.40; P ⫽ .75), it was evident that the (c) the effectiveness of the therapists, (d) their confidence in
average frequency of practice declined over time for both con- recommending the intervention to a friend, (e) how logical the
ditions. intervention seemed as a means for stress management, and
Participants recorded their levels of tension before and after (f) how important they believe it is that the intervention be made
home practice of relaxation or meditation. These tension ratings available to others. The overall MANOVA was not statistically
were averaged across each week of at-home practice reported by significant (F[1, 25] ⫽ 2.10; P ⫽ .10). However, those in the
each participant, yielding four weeks of prepractice and postprac- PMR condition were found to report significantly higher levels
tice tension ratings. Four separate repeated measures ANOVAs of skills mastery than those in the MM condition (F[1, 25] ⫽
were used to test whether participants in the PMR condition 13.27; P ⬍ .05). Overall, participants in both treatment condi-
would report greater changes in levels of tension from preprac- tions reported experiencing a moderate degree of stress reduc-
tice to postpractice than those in the MM condition. Although tion, and rated the therapists as “moderately effective” to “very
overall tension reduction occurred from prepractice to postprac- effective.”
tice of stress management skills, there were no significant be-
tween-group differences found at week 1 (F[1, 28] ⫽ 2.09;
P ⫽.16), week 3 (F[1, 22] ⫽ 0.76; P ⫽.39), or week 4 (F[1, 12] ⫽
0.48; P ⫽.50). A significant between-group difference did DISCUSSION
emerge during week two, however, indicating that those in the The present study tested the effectiveness of a five-week MM
PMR condition experienced significantly greater reductions in intervention by directly comparing it to a well-accepted alterna-
tension than participants in the MM condition (F[1, 27] ⫽ 5.64; tive stress management technique (PMR) among a sample of
P ⫽.03). Thus, the hypothesis that the PMR condition would community adults. Although the sample for this study was fairly
experience greater levels of relaxation than the MM condition homogeneous in terms of their demographic characteristics, ran-
was at least partially supported. Table 2 includes statistics on domization checks revealed that there were no significant be-
participants’ at-home skills practice, including frequency of tween-group differences at baseline with regard to participants
practice and subjective ratings of tension before and after prac- scores on outcome measures, or for their expectations for the
tice. intervention. None of the study variables examined in this study
were found to be significant predictors of attrition. The relatively
high rate of completion (94.7%) for the MM intervention tested
in the present study is similar to previously reported completion
Table 2. Self-Rated Tension and Frequency of At-Home Skills Prac- rates for MBSR programs,16,17 confirming that the intervention
tice by Treatment Condition
was well-tolerated by participants. Similar to the results of Jain
Frequency of Skills Prepractice Postpractice and colleagues,5 participants in both interventions experienced
Treatment Practicea Tensionb Tensionb decreases in psychological distress, as measured by scores on the
Condition Mean (SD) Mean (SD) Mean (SD) BSI general severity index and self-report evaluations by partic-
MBSR ipants, although neither treatment proved superior to the other
Week 1 5.36 (3.58) 3.15 (0.55) 2.36 (1.15) in decreasing distress.
Week 2 4.47 (3.64) 3.17 (0.52) 2.55 (1.30) In addition to the higher rates of treatment completion for the
Week 3 3.16 (2.71) 3.26 (0.58) 2.15 (1.01) MM group, one of the more notable findings from the present
study was that those in the MM condition practiced MM twice
Week 4 2.05 (3.17) 3.17 (0.72) 2.40 (1.49)
as often as their counterparts practiced PMR. This finding is
Overall 15.05 (8.84) 3.26 (0.44) 2.28 (1.13)
contrary to the results of Jain and colleagues,5 who found no
PMR
differences between meditation and relaxation conditions in the
Week 1 2.92 (3.61) 3.08 (0.63) 1.68 (0.68) amount of time spent practicing these skills outside of sessions.
Week 2 2.71 (3.50) 3.35 (0.94) 1.76 (0.63) Contrary to our original hypotheses for the present study,
Week 3 1.42 (2.34) 2.97 (0.70) 1.54 (0.57) however, neither relaxation nor mindfulness emerged as more
Week 4 0.71 (1.68) 2.92 (0.83) 1.63 (0.95) prominently associated with MM or PMR. One possible expla-
Overall 7.75 (8.64) 3.22 (0.65) 1.68 (0.63) nation for this lack of significant increase in mindfulness among
MBSR, mindfulness-based stress reduction; PMR, progressive muscle relax-
MM participants is that a five-week mindfulness course may not
ation. be intensive enough to result in significant changes in partici-
a
Total number of at-home practices of either mindfulness meditation or pants’ levels of mindfulness. This explanation is indirectly sup-
PMR, tallied from participants’ completed home practice records. ported by the fact that although participants in the present study
b
Rated on a scale from one (very relaxed) to five (very tense). were less likely to practice PMR than MM, participants who

108 EXPLORE March/April 2009, Vol. 5, No. 2 Comparing Brief Stress Management Courses
learned PMR reported significantly greater skills mastery than
those who learned mindfulness skills. As suggested by Brown
and Ryan,11 longer periods of mindfulness training than a few
weeks may be required to notice any significant increases in
mindfulness. At the outset of this research project, the MAAS11
was the only published measure of mindfulness in existence.
Given that the MAAS has been noted to be a unidimensional
measure of mindfulness, assessing only the degree to which a
respondent reports acting with awareness versus acting automat-
ically,18 it is possible that more comprehensive measurement of
mindfulness may have yielded more meaningful information
about the process-level differences between mindfulness and
PMR. Although it is clear that mindfulness is effective in reduc-
ing distress when compared to PMR, the respective roles of
relaxation and mindfulness remain unknown.
Limitations and Future Directions
The primary limitations of the present study were the relatively
small sample size and the lack of a no-treatment control condi-
tion. Given that several of the statistically nonsignificant, be-
tween-group differences found in this study were in the expected
direction, it is possible that a larger sample would have increased
the statistical power needed to detect meaningful differences. A
wait-list control condition would have offered a further basis for
comparison, helping to better elucidate the nature of the differ-
ences between the MM and PMR interventions.
Another limitation of this study, as discussed above, was the
failure to adequately detect or measure changes in mindfulness
from pretreatment to posttreatment. Anecdotally, several partic-
ipants reported that as they practiced mindfulness more, they
began to view themselves as less mindful than before participat-
ing in the intervention. This represents an interesting problem
for measurement, not unlike shooting at a moving target. Future
research on mindfulness-based interventions would benefit
from development of more objective, behavioral measures of
mindfulness, such as performance on validated measures of
complex attention and concentration as commonly used in neu-
ropsychological testing. In addition, as suggested by Caspi and
Burleson,19 future studies of meditation-based interventions
should use qualitative methods, particularly in gathering data
about participants perceptions of the quality of their meditation
experiences. Given the low overall rates of skills practice ob-
served in the present study, future research of mindfulness-based
interventions should also seek to examine which treatment fac-
tors may help improve rates of practice of mindfulness skills.
Taken in combination with the results of Jain and colleagues,5
the results of the present study indicate that a brief mindfulness
course may be effective as a means of stress management. Al-
though greater skills mastery was reported by those who learned
PMR, those in the MM condition had higher rates of home
practice of stress reduction skills, as well as higher overall rates of
treatment completion. Further, given that the skills taught in
mindfulness-based interventions may be also found in contexts
other than traditional mental health settings (eg, yoga or medi-
tation classes offered in the community), an added bonus of
these types of interventions is that participants will more readily
Comparing Brief Stress Management Courses
have access to opportunities for continued group-supported
practice of valuable stress management skills.20
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