Mindfulness predicts reduced aberrant salience and improves stress management

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Aberrant salience, the exaggerated assignment of salience, is associated with psychotic experiences, but the effects of mindfulness on aberrant salience are unexplored. To address this, we conducted a pre-post-intervention pilot study, with 21 participants undergoing an 8-week course of Mindfulness-Based Health Promotion (MBHP). Quantitative and qualitative measurements were conducted before (T0), immediately after (T1), and three months after the course (T2). Primary outcome was aberrant salience (Aberrant Salience Inventory, ASI). Secondary outcomes included quantitative scales on mindful attention (Mindful Attention Awareness Scale, MAAS) and decentering (Experiences Questionnaire, EQ), and qualitative reports on participation motivations, preferred practices, learnings, and stress management. Correlations included quantitative changes over time (T1-T0, T2-T0, and T2-T1). The results show that the ASI factor Heightened Cognition increased post-course (T1-T0), while ASI Heightened Emotionality (T2-T0) and total aberrant salience (T2-T1) decreased. MAAS and EQ scores increased (T1-T0, T2-T0). MAAS scores (T1-T0, T2-T0) correlated negatively with ASI Heightened Emotionality (T2-T0). Qualitative analyses indicated consistent stressors but improved stress management, applying the course contents and integrating mindfulness into everyday life, even three months afterward. In conclusion, along with improved well-being and stress management, mindfulness might modify pre-attentional and attentional processes such as reduced aberrant salience, besides enhanced mindful attention and decentering. Importantly, mindful attention might predict and promote aberrant salience reductions, warranting future research on treatment approaches and mechanisms of mindfulness in psychosis. Mindfulness Mindfulness-Based Health Promotion aberrant salience attention awareness motivations learnings stress management psychosis Figures Figure 1 Figure 2 1 Introduction Mindfulness is the “awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment” [ 1 , p.2]. Mindfulness research has considerably grown over the last forty years, showing benefits in cognitive functioning, well-being and health across clinical and non-clinical populations [ 2 ]. It originates from Eastern contemplative traditions and was adapted to Western culture within Mindfulness-Based Stress Reduction (MBSR), a 10-week training program to aid patients with chronic pain [ 3 ]. Mindfulness-Based Health Promotion (MBHP) is inspired by MBSR but adapted to the Brazilian context with has a shorter, 8-week duration; it stands out for its comprehensive approach to health promotion, unrestricted to specific pathologies [ 4 ], [ 5 ]. Accordingly, MBHP has shown benefits in diverse contexts and populations, such as improved anxiety and depression in police officers [ 6 ], burnout symptoms in primary health care providers [ 7 ], stress, resilience, and immune function in teachers [ 8 ], muscular pain in nurses [ 9 ], and overweight in women [ 10 ]. However, the mechanisms driving the benefits of MBHP on health and well-being remain inadequately elucidated, with the long-term benefits of such interventions requiring further investigation. Additionally, there is a need for comprehensive studies to assess the feasibility and effectiveness of MBHP across diverse populations and various health outcomes. MBHP is based on the key elements of attention, intention, and attitude [ 11 ]. It emphasizes the importance of conscious attention anchored in the present, the intention to remain focused, and the ability to redirect attention, along with Kabat-Zinn’s mindful attitudes. Both course concepts emphasize the development of attentive and receptive presence as the core of mindfulness practice. Accordingly, mindfulness practice is linked to changed attentional and pre-attentional processes, including attention, awareness, and decentering [ 12 ], [ 13 ]. Beyond that, mindfulness practices might influence pre-attentional processes such as salience. Salience is the prominence of a perceived element (e.g., an object or idea) that automatically catches attention, such as a red apple on a green tree. Salience is a fundamental adaptive mechanism for optimally interacting with our environment [ 14 ]. Mindfulness training reduces reward salience [ 15 ], first-person perspective salience [ 16 ] and defensive responses to mortality salience [ 17 ]. Within the brain, mindfulness training increases the connectivity in the salience network [ 18 ]. On the other hand, aberrant salience is the exaggerated assignment of importance to perceived elements. Originally, the concept has been proposed as mechanism underlying the symptoms in psychotic disorders [ 19 ]. Specifically, the work hypothesized that hallucinations and delusions are generated by a dysregulation and hyperdopaminergic state of the brain, promoting an aberrant attribution of salience to one’s experiences. In fact, aberrant salience has been associated with negative symptoms in schizophrenia and psychotic experiences in first-episode psychosis and healthy controls [ 20 ], [ 21 ]. Moreover, aberrant salience predicts anomalous and paranormal experiences [ 22 ], is increased with LSD and cannabis use [ 23 ], [ 24 ], and mediates the development of schizotypal symptoms in cannabis users [ 25 ]. Mindfulness has shown beneficial effects in psychotic disorders, particularly on negative symptoms and symptom severity [ 26 ], but the mechanisms underlying these benefits are largely unexplored and the impact of mindfulness on aberrant salience unknown. Considering the potential of mindfulness to improve diverse mental conditions, including psychotic disorders, and modulate attention and salience, in this pioneer research, we aimed to explore the feasibility of mindfulness to reduce aberrant salience in a pilot study. For a more comprehensive understanding of the mechanisms and context of such effects, we furthermore sought to identify changes in attention and decentering, motivations for enrolling in a MBHP course, practicing habits, learnings, and stress management in the short and long term. 2 Material and Methods 2.1 Design This is a pre-post-intervention pilot study with a follow-up assessment to test the effects of mindfulness training on aberrant salience. We conducted an 8-week MBHP course at the cultural center of the University of Campinas, Brazil, with measurements immediately before the first session (T0), right after the last session (T1), and three months afterwards (T2). This study was approved by the university’s Research Ethics Committee (#93622718.0.0000.5404). The study design, measurements, and participant number are illustrated in Fig. 1 . 2.2 Participants Healthy Portuguese-speaking adults were recruited to participate in a free MBHP course via announcements on the website of the university’s cultural center ( https://www.casadolago.proec.unicamp.br ). Candidates attended an introductory lecture about MBHP and were invited to voluntarily also participate in the study. They completed a health evaluation questionnaire, screening for acute symptoms of psychiatric or organic disorders and personality disorders, as the course is typically not recommended for these conditions. All 22 candidates were selected, provided informed consent, and participated in the course and study. 2.3 Mindfulness Intervention MBHP, similar to established mindfulness programs like MBSR, aims to foster awareness, the conscious recognition of internal (thoughts, emotions, sensations, impulses, behaviors) and external (activities, relationships, etc.) phenomena [ 4 ]. Through the cultivation of daily awareness, it aims to improve conscious decision-making and reduce reactivity. For this, MHBP promotes regular engagement in formal and informal mindfulness practice, focusing on attention, attitude, and intention. The MBHP protocol is an 8-week structured program comprising weekly 2-hour sessions to explore techniques and learn about full attention. The sixth session features contemplative silence, mirroring the silent retreats in MBSR programs but adapted for implementation in organizations and public services. Participants receive formal practices for daily exercise at home or work, lasting 15 min on average but up to 45 min for committed participants. They are also guided to conduct informal practices, using daily routines as opportunities to exercise full attention. Key four techniques include mindful breathing, body scanning, mindful walking, and light mindful movements suitable for people with physical limitations. Attentional focus in mindful breathing is on the breath; in body scanning, on sensations throughout the body; and in walking and movements, on the moving body. Additional techniques include practices with compassion, self-compassion, sounds, thoughts, open monitoring, and the three steps (body perception ‒ respiration ‒ body perception). Psychoeducational dynamics include “primary and secondary suffering” and “hello, thank you, goodbye” and aim to facilitate understanding the meditative practices [ 4 ], [ 27 ]. 2.4 Measurements Beyond our primary focus on aberrant salience, we incorporated both quantitative and qualitative measurements as secondary outcomes for a comprehensive understanding of attentional processes, learnings, and motivations related to mindfulness training. Measurements were conducted by pen and paper (T0, T1), and online (T2). 2.4.1 Primary Outcomes The Aberrant Salience Inventory (ASI) assesses the aberrant salience trait through 29 yes-no questions and five factors (Increased Significance; Senses Sharpening; Impending Understanding; Heightened Emotionality; Heightened Cognition) [ 28 ]. Each factor measures a unique aspect of the construct: Increased Significance evaluates the excessive importance attributed to trivial events; Senses Sharpening reflects an intensified sensory perception; Impending Understanding captures a feeling of being on the brink of an important revelation; Heightened Emotionality involves stronger emotional reactions to everyday stimuli; Heightened Cognition reflects the feeling of being part of something important. The English scale was translated into Brazilian Portuguese by our team; validation is in progress. 2.4.2 Secondary Outcomes Quantitatively, mindfulness skills were examined repeatedly by the Mindful Attention Awareness Scale (MAAS) measuring mindful attention and awareness by 15 items on a 6-point Likert scale (1 = almost always; 6 = almost never) [ 12 ], [ 29 ]. The Experiences Questionnaire (EQ) measures decentering by 20 items on a 5-point Likert scale (1 = never; 5 = always) [ 30 ]. The Brazilian version’s single-factor structure has been confirmed, although findings are yet to be published (P. Lucena-Santos, personal communication, 29 June 2020). Qualitatively, open-ended questionnaires examined primary motivations for seeking the course and the subjective understanding of mindfulness (T0), key learnings and preferred practices (T1, T2), and main stressors and coping mechanisms (T0, T1, T2) (the complete questionnaires are provided in the Supplementary Methods). Paper-based questionnaires were subsequently transcribed. The data were interpreted by a Content Analysis, comprising three phases of pre-analysis (research corpus), analytical description, and final analysis [ 31 ]. 2.5 Statistical Analysis Quantitative data were analyzed using IBM SPSS Statistics (version 22). A repeated measures General Linear Model (GLM rep ) with ‘time’ (T0, T1, T2) as a within-subjects factor was used for MAAS and EQ. For the ASI, the GLM rep included an additional within-subject factor ‘scale factor’. Main effects of time were examined, followed by pairwise comparisons for each factor and time point. Effect sizes were estimated using partial eta squared ( η p 2 ). Spearman’s rank correlations ( r s ) were calculated between time-dependent changes for pre-post (T1-T0), pre-follow-up (T2-T0), and post-follow-up (T2-T1) intervals. Significance threshold was set at α = 0.05, two-tailed. All p -values were Bonferroni-corrected post hoc for multiple comparisons. 3 Results 3.1 Participants During the course, one participant withdrew for personal reasons, leaving 21 participants for final analysis (Fig. 1 ). Table 1 shows the demographic characteristics of the participants who completed the study. Participants were predominantly female, middle-aged, in a partnership, and highly educated. Table 1 Demographic characteristics of the final sample Characteristic a Categories Value Participants study completed study not completed 21 (95.5%) 1 (4.5%) Age years (mean ± SD; range) 40.8 ± 12.8; 23‒73 Sex female male 16 (76.2%) 5 (23.8%) Marital status single married/in partnership 8 (38.1%) 13 (61.9%) Education years (mean ± SD; range) 20.5 ± 4.2; 15‒30 Profession therapist/psychologist professor/teacher student statisticians/system analysts biologist/chemists entrepreneur physician/nurse housewife 4 (19.0%) 3 (14.3%) 5 (23.8%) 3 (14.3%) 2 (9.5%) 1 (4.8%) 2 (9.5%) 1 (4.8%) a Characteristics were assessed by self-reports. 3.2 Primary Outcomes Regarding aberrant salience, there was a main effect of time in ASI for the quadratic, but not linear, within-subjects contrast ( F (1,20) = 7.7, p = 0.011, h p 2 = 0.28), implying that mindfulness training was related to non-linear alterations in aberrant salience. Pairwise comparisons demonstrated increased Heightened Cognition at T1 compared to T0 ( p = 0.001), decreased Heightened Emotionality at T2 compared to T0 ( p = 0.019), and decreased Total at T2 compared to T1 ( p = 0.042). Moreover, there were increases in Senses Sharpening at T1 compared to T0 ( p = 0.031) and decreases in Heightened Emotionality ( p = 0.033) and Heightened Cognition at T2 compared to T1 ( p = 0.031), but these effects did not survive correction for multiple testing (Fig. 2 A). Mindfulness increased over time (see 3.3. Secondary Outcomes, Fig. 2 B) which was related to reduced aberrant salience, as reflected by negative correlations between MAAS (T1-T0 and T2-T0) and ASI Heightened Emotionality (T2-T0) ( r s = -0.64, p = 0.020 and r s = -0.64, p = 0.023). Overall, this indicates that mindful attention gains might predict and promote long-term reductions in emotional aberrant salience (Fig. 2 C). ASI: Aberrant Salience Questionnaire; MAAS: Mindful Attention Awareness Scale; EQ: Experiences Questionnaire; T0: before the course; T1: after the course; T2: three months after the course; T1-T0: difference between after the course and baseline; T2-T0: difference between three months after the course and baseline 3.3 Secondary Outcomes Quantitatively, mindfulness-related skills improved over time with main effects for MAAS ( F (1,20) = 80.0, p < 0.001, h p 2 = 0.80) and EQ ( F (1,20) = 40.8, p < 0.001, h p 2 = 0.67). Pairwise comparisons revealed increases in MAAS and EQ at T1 and T2, compared to T0, respectively (all p < 0.001). This suggests that mindfulness training promoted short- and long-term mindful attention, awareness, and decentering. Moreover, MAAS was increased at T2 compared to T1 ( p = 0.025), indicating continuing enhancements in attention and awareness after the course’s conclusion up to three months (Fig. 2 B). As for correlations, MAAS (T1-T0) correlated highly positively with MAAS (T2-T0) ( r s = 0.80, p < 0.001), indicating that attention enhancements during the course might predict enhancements three months later. Qualitatively, a detailed description on the creation of categories within motivations, course meaning, learnings, preferred practices, mindfulness understanding, stressors, and stress management related to MBHP participation is provided in the Supplementary Results. This includes also a rich dataset of verbatim quote examples. Table 2 resumes the categories and distributions for these measurements. Table 2 Motivations, course meaning, learnings, preferred and continued practices, mindfulness understanding, stressors, and stress management related to Mindfulness-Based Health Promotion (MBHP) before the course (T0), immediately afterwards (T1), and three months afterwards (T2) Measurement Time point Categories Count (%) Motivation T0 Stress reduction and emotional regulation Greater presence, awareness, and well-being Self-awareness, self-care, and self-development Enhanced concentration, focus, and attention Join a group for practice: 20 (34%) 13 (22%) 11 (19%) 8 (14%) 6 (10%) Course meaning T1 Pause, self-awareness, and self-care Well-being Restart, a new way of life Self-development Improvement in relationships 21 (34%) 11 (18%) 10 (16%) 10 (16%) 9 (14%) Learnings T1 Greater presence, awareness, and well-being Self-compassion and compassion Acceptance, kindness, and care Reduced rumination and expanded perspective Primary and secondary suffering Importance of the group 21 (30%) 15 (21%) 14 (20%) 12 (17%) 5 (7%) 3 (4%) T2 Increased awareness and well-being Self-perception and broadened perspective Self-compassion and compassion Increased concentration 11 (39%) 7 (25%) 6 (21%) 5 (18%) Preferred practice T1 Breathing Three steps Sounds and thoughts Body scanning Walking Self-compassion 11 (28%) 8 (20%) 7 (18%) 5 (13%) 5 (13%) 4 (10%) T2 Breathing Sounds and thoughts Three steps Self-compassion and compassion Body scanning Walking Mindful eating 10 (26%) 9 (23%) 5 (13%) 5 (13%) 4 (11%) 3 (8%) 2 (5%) Practice continuation T2 continue formally continue informally/do not continue 16 (76%) 5 (23%) Practice duration T2 min/week (mean ± SD; range) 46.4 ± 49.5; 0‒210 Mindfulness understanding T0 Living with presence Meditation technique Beginner’s mind, non-judgment, acceptance 21 (52%) 9 (24%) 8 (21%) T1 Awareness, presence Acceptance, real life Well-being, peace 16 (40%) 14 (34%) 11 (27%) T2 Presence, awareness Well-being Acceptance 14 (48%) 11 (38%) 4 (14%) Stressor T0 Work Relationships Health issues 18 (46%) 17 (44%) 4 (10%) T1 Work Relationships Health issues 6 (43%) 5 (42%) 3 (21%) T2 Work Relationships Health issues 11 (61%) 4 (22%) 3 (17%) Stress management T0 Lack of resources Anxiety, fatigue Low self-esteem, discouragement, self-demand Task procrastination Others 14 (35%) 13 (33%) 7 (18%) 3 (8%) 3 (8%) T1 Reduced automatic reactions, increased reflection, and choice Increased tranquility and calmness Acceptance Improvement in relationships 15 (29%) 15 (29%) 12 (24%) 9 (18%) T2 Self-perception, broadened perspective Pause Breathing, body-awareness Acceptance, non-judgment, trust, patience 12 (29%) 11 (27%) 9 (22%) 9 (22%) Motivations (T0) for seeking MBHP predominantly included tools for stress coping, emotion regulation, more presence, and well-being, but also self-care and development, concentration, and attention. Some individuals with meditation experience wished to find a group to continue their practices. Accordingly, most participants experienced the course (T1) as an opportunity for pause, well-being, self-care, and -development, as reflected in the statement: “This course represented a commitment I made to take better care of myself” (P18). Similarly, important learnings comprised awareness, well-being, and (self-)compassion (T1, T2), but also acceptance, kindness, reduced rumination (T1), self-perception, and broadened perspective (T2). Moreover, motivations and learnings reflected the perceived meaning of mindfulness overall as presence and acceptance (T0-T2), but also awareness and well-being after participation (T1, T2). Preferred practices were similar at T1 and T2, including breathing, three minutes, and sounds and thoughts, but also body scanning, walking, and self-compassion. Most participants practiced formally (~ 46 min/week) and all participants practiced informally after three months. Stressors remained consistent with participants highlighting work, relationships, and health issues (T0-T2). “Work” was interpreted broadly, including excessive professional demands and pressure, job instability, appropriate remuneration, balancing job responsibilities with household and childcare, and professional fulfillment. “Relationships” encompassed factors like the end of long-term relationships and general misunderstandings, from close family ties to casual interactions (e.g. with strangers in traffic). “Health issues” included personal problems (e.g., phobias) or caring for a sick parent. Regarding stress management, participants first mainly reported lacking resources to handle stress (T0). They described anxiety, fatigue, issues of self-esteem, and self-demand, which might have derived from this perceived deficiency, as illustrated by the statements: “I haven’t been able to cope and everything seems to be piling up in my mind without a peaceful solution” (P21) and “I feel like a ‘bomb’ could go off at any moment” (P5). After the course, all participants reported shifts in stress management, with an enhanced capacity for reflection, choice, and calmness as stated here: “My automatic reactions have greatly diminished. My ability to reflect has increased.” (P2) and “Lately, the most significant stressor is my 2-year-old’s tantrums. I’ve been trying to pause, become aware of my breathing, body, the sensations... I distance myself briefly until calm and then resume” (P1). 4 Discussion This is the first study, to the best of our knowledge, to explore the interaction between mindfulness and aberrant salience. After the 8-week course, total aberrant salience and the factor Heightened Emotionality decreased, while mindful attention and decentering increased over time. Correlations suggest that increased mindful attention post-course predicts decreased Heightened Emotionality after three months. Moreover, mindfulness and aberrant salience decreases were correlated after three months. Beyond that, our qualitative results indicated that motivations of stress reduction, emotion regulation, awareness, well-being, and self-care mostly matched the perceived course meaning, learnings, and mindfulness understanding short- and long-term. Most participants continued practicing formally and showed similar preferred practices over time. While stressors remained stable, their coping changed from self-reported lack of resources and negative implications to more controlled, reflective decisions, tranquility, and acceptance short- and long-term. 4.1 Mindfulness, Attention and Aberrant Salience Mindfulness training seemed to exert contrasting effects on aberrant salience. The factor Heightened Cognition was increased after the course. This is not surprising, considering that this factor was conceptualized as the feeling of being part of something mystically, spiritually, or intellectually important, of approaching true awareness and understanding [ 28 ]. Similarly, Senses Sharpening (improved sensory perception and awareness) was tendentially increased post-course but not after three months, suggesting that MBHP might promote transitorily but not enduringly perceived improved sensorics, highlighting the contrast to psychotic-related phenomena [ 25 ], [ 28 ]. Notably, aberrant salience was measured immediately after the last class (T1), in contrast to T0 (before the first class) and T2 (without any class). This may indicate that the just-finished class, rather than the overall 8-week course, could have impacted these outcomes, reinforcing the immediate, transient nature of effects. This aligns with tendentially reduced Heightened Cognition at T2 compared to T1, pointing to a reversion to baseline. Conversely, total aberrant salience decreased long-term compared to post-course, and Heightened Emotionality decreased long-term compared to baseline. These findings could suggest a dampening impact of MBHP and continued practice on aberrant salience, particularly regarding the processing of aberrant, confusing, overwhelming, and negative emotions [ 28 ]. This is in line with consistent reports of mindfulness promoting emotion regulation, emotional well-being, and health [ 32 ]. Notably, short- and long-term mindful attention correlated negatively with long-term Heightened Emotionality. This indicates that attention and awareness might constitute important mechanisms for emotional aberrant salience, with post-course mindful improvements predicting and long-term mindful improvements mirroring emotional improvements. Similarly, previous research reported baseline awareness to predict greater positive and lower negative affect after MBSR [ 33 ], underlining the importance of mindful awareness for emotion regulation. As expected, mindful attention and awareness were enhanced post-course and continued to rise three months afterward, probably related to continued practice. This aligns with the notion of attention and awareness being core aspects of mindfulness and consistent findings of mindfulness improving diverse attentional processes, including generalized attention, alerting, executive control, inhibition [ 34 ], and meta-awareness, the awareness of experiencing internal processes like sensations, thoughts, and emotions [ 35 ]. Similarly, decentering was increased in the short and long term. Decentering is the “ability to observe one’s thoughts and feelings as temporary, objective events in the mind” [ 30 , p.1], closely related to meta-awareness, robustly increased by mindfulness practices, and related to improved well-being and mental health [ 36 ]. Interestingly, the correlations between increased attention after MBHP and increased attention after three months, together with the continued practices, might suggest that course performance might predict long-term mindful capacity gains. Overall, our results suggest that mindfulness training may influence diverse attentional processes, including pre-attentive salience, mindful attention, awareness, and decentering. While guided group practices enhanced the vague sense of belonging to something important (Heightened Cognition), continuous, individual practice reduced aberrant salience and overwhelming negative emotionality (Heightened Emotionality), which was predicted by and related to mindfulness improvements. These correlations emphasize the notion of mindful attention exerting strong influence on aberrant salience, at least regarding its emotional aspects. Aberrant salience, a concept from psychosis research to understand the mechanisms of psychotic experiences and increased by psychedelics [ 20 ], [ 23 ], might therefore provide an intriguing new perspective on understanding the effects of mindfulness on pre-attentional processing. Beyond that, considering that mindfulness has been proposed as efficient adjunct for pharmacotherapy in psychosis [ 26 ], our results encourage its further investigation as complementary treatment approach, particularly for emotional distress in patients with psychotic disorders. 4.2 Motivations, Learnings, and Stress Management The qualitative findings indicate a primary motivation to join MBHP of finding tools for stress reduction and emotion regulation . This aligns with the objectives of the inaugural mindfulness program and its efficacy in alleviating stress and anxiety [ 3 ], [ 37 ]. Such findings underscore that the allure of mindfulness courses remains today, notably, within our Brazilian sample. Other predominant motivations were presence, awareness, and well-being , alongside self-awareness, self-care, and self-development , indicating aspirations for a holistic sense of well-being beyond stress alleviation. This aligns with the notion of well-being as a multifaceted phenomenon beyond the mere absence of psychopathology, encompassing diverse factors such as cultural nuances, socioeconomic factors, health status, quality of intra- and interpersonal relationships, and psychological processes, and personal growth [ 38 ], [ 39 ]. Beyond the strong pursuit of emotional balance and holistic well-being, the wish to enhance concentration, focus, and attention emerged less often. This was unexpected since attention training is a core aspect of mindfulness practices [ 34 ]. This may be attributed to Brazil’s demanding reality at that time, as described in the following: “In Brazil, the current government’s political landscape has become a major stressor, especially for those of us in public education. Dealing with this stressor has been increasingly difficult” (P8). “A stressor for me is being in temporary employment and uncertain about my professional path after this period. The country’s political, economic, and ethical instability, directly impacting my work environment (academic research), is concerning” (P2). This may also be an explanation for why “work” remained the main stressor over time. Regarding learning, most participants reported greater presence, awareness, and well-being in the short and long term, according to their initial motivations. The concurrent appearance of higher awareness and well-being corroborates with findings linking awareness with happiness and well-being [ 40 ]. Greater awareness of thoughts and feelings might have contributed to the expanded perspectives preventing participants from being overwhelmed, thereby promoting well-being, aligning with the Broaden-and-Build Theory of Positive Emotions [ 41 ]. Moreover, many reported acceptance, kindness, and care , beyond compassion and self-compassion . These mindfulness qualities have been described to encompass the understanding that suffering exists in every person but does not need to define them; instead, one can acknowledge its common experience and offer kindness rather than self-judgment [ 42 ]. The alignments of these notions with the course learnings support its efficacy. The endurance of these learnings up to three months may be attributed to the continued formal and informal practices, integrating mindfulness into everyday life. According to the motivations and learnings, the course meaning was described afterward as an opportunity for pause , self-care , and well-being , but also a new way of living , as eloquently described here: “a door that opened to a more colorful, intense, and meaningful life” (P2). This is consistent with MBHP’s objective to trigger a new, mindful way of life [ 4 ], and aligns with all participants continuing to practice informally after three months, most of them even formally. The preferred practices varied according to the individual life moments of the participants, as expected within dynamic and continuous learning processes. Nevertheless, they showed remarkable similarities at T1 and T2, with breathing, three steps, and sounds and thoughts as favorites, followed by body scanning, walking, and self-compassion. Regarding the meaning of mindfulness , in the beginning, participants demonstrated technical knowledge, distinguishing between formal and informal practice and some mindful attitudes, such as presence and non-judgment [ 1 ]. After the course, responses seemed to shift from technical to experiential, including real life , well-being , and peace , suggesting that rationalizing mindfulness provides just one facet of experiencing and practicing it. Although the stressors of work, relationships, and health issues remained constant over the whole time, participants changed their way of dealing with them. First, they lacked resources and responded with anxiety, fatigue, and discouragement. In short and long term, they highlighted increased reflection, perception, tranquility, and acceptance, among others. This is reflected, for example, in reports on increased awareness of internal contents and processes: “When I have intense thoughts of self-criticism and self-demand, I can perceive that they are not real, accept myself more as I am, and show self-compassion by recognizing my limitations” (P13). This may indicate that MBHP and continuous practice affected the mental capacities for handling stressors, allowing for more awareness and emotional regulation. This aligns with MBHP’s main objective of stress reduction by decreasing automatic reactions and increasing conscious decision-making [ 4 ]. For this, participants are guided that nothing needs to be achieved and everything that arises can be accepted and embraced, aligning with the notion that reduced resistance to the mind’s contents diminishes suffering [ 43 ]. 4.3 Synthesizing Primary and Secondary Outcomes A hitherto unexplored process in mindfulness research is aberrant salience . Most prominently, we found increased Heightened Cognition (sense of achieving a deeper understanding and being part of something spiritually or intellectually important). It was enhanced after the course despite its secular nature and focus on attention training. This increase may also be reflected in simultaneous qualitative reports of a new way of living, self-development (course meaning), expanded perspective, awareness, presence (learning, mindfulness understanding), and reflection (stress management), as described here: “I feel like a portal of knowledge has opened, about better ways of living and perceiving time, events, my own emotions and thoughts” (P2), “It was a watershed in the perception of thoughts and emotions, it gave me tools to experience the present” (P1) and “It represented an incredible experience of being able to observe my interior, my thoughts, my desires” (P22). The transient Heightened Cognition increases might have been promoted by the group setting, considering that group importance (learnings) and improved relationships (stress management) were highlighted at T1 but not T2, in line with previous findings of advantages of group to solitary meditation [ 44 ]. Contrastingly, we discovered reduced total aberrant salience (T2 compared to T1). This might be reflected in reports as: “I can identify more clarity in situations where I previously let myself be dominated by thoughts and feelings” (P6) and “I feel more attentive to the fact that I do things by living them, perceiving them” (P21). The reduced aberrant salience seemed principally attributable to the reduced Heightened Emotionality (confused, overwhelming, or negative emotional processing). Decreased Heightened Emotionality is echoed in qualitative findings on more well-being, compassion (learning, mindfulness understanding), self-perception, capacity for pause, and patience (stress management), suggesting diminished overwhelming sensations and more balanced emotion processing. Similarly, the quantitative rises in decentering (T1 and T2) dovetails with qualitative reports of more self-development (motivations T0, course meaning T1), self-perception, broadened perspectives (learning T1 and T2, stress management T2), and detachment from emotions and thoughts, as observed here: “This course represented for me a discovery that observing thoughts and directing their course is possible” (P4) and “I noticed a difference, especially concerning negative thoughts. I realized that they do not define me” (P10). This combines with the notion of mindfulness enhancing emotion regulation, positive emotions, and self-compassion, and reducing negative emotions, which relates to improved mental health, stress, and depression [ 45 ]. Interestingly, mindful awareness and attention were key aspects in motivations, learning, course meaning, and mindfulness understanding. These included more presence and concentration (learning and mindfulness understanding T1 and T2), self-awareness (course meaning T1), awareness of internal processes, reflection, conscious decision-making, and self-awareness (stress management T1 and T2), suggesting that the initial objectives were met. These qualitative reports were accompanied by quantitative increases in mindful attention and awareness throughout the study, with post-course predicting long-term improvements. This points to the consistency of our findings and an overall robust phenomenon, aligning with the importance of attention and awareness in mindfulness practices [ 34 ], [ 35 ]. Importantly, the correlations between short- and long-term attention and awareness with long-term decreased Heightened Emotionality might point to mechanisms underlying these aberrant salience reductions, suggesting the potential feasibility of attentional training to alter pre-attentional emotional and perceptional mechanisms, as mirrored in this statement: “Today it really means full attention to what you do, no matter how insignificant the action seems to me. It's the de-automatization of everything you do, it's living in a dynamic way so you can understand the world around you” (P21). Overall, this relationship might pinpoint a potential therapeutic mechanism in patients with psychotic disorders [ 46 ], warranting further investigation. According to the motivations of reduced stress and better emotion regulation, all participants reported improved stress management capacities. With initial deficiencies, they reported reduced automatic responses, enhanced reflections, choices, and calmness (T1), and enhanced self-awareness, perspective, and reflection (T2). The qualitative and quantitative enhancements in attention, awareness, and decentering point to possible mechanisms underlying these changes. Awareness, attention, presence, and acceptance can contribute to de-automatization, increasing self-control and well-being [ 47 ], potentially accounting for our reduced automatic reactions (stress management) and improved well-being (learning, course meaning, and mindfulness understanding). Similarly, decentering may promote reduced distress and emotional reactivity and increased well-being and mental health [ 36 ]. Therefore, our findings might suggest cognitive mechanisms of improved attention, awareness, decentering and potentially aberrant salience underlying mindfulness-induced improved stress management. Future research should better explore the connection between aberrant salience, emotion regulation and stress management. 4.4 Limitations We used baseline comparisons and no placebo control, which means placebo and carryover effects cannot be ruled out. Furthermore, the T1 measurements may be disproportionately influenced by the last class shortly before, compared to T0 (before the first class) and T2 (without class), potentially amplifying the effects, particularly regarding Heightened Cognition (ASI). Moreover, the small and non-representative sample, being predominantly female and highly educated, might have influenced measurements such as motivations, learnings, and stressors. Relationships between changes in stress management and mindful attention and aberrant salience remain uncertain since stress management was not assessed quantitatively. Future studies should assess these quantitatively in a more rigorous, controlled, randomized design. 5 Conclusion This pilot study investigated the feasibility of mindfulness to reduce aberrant salience in the short and long term. We also aimed to explore related attentional processes, motivations, learnings, and stress management. Overall, mindfulness seemed to decrease aberrant salience, with correlations pointing to a crucial role of mindful attention for improving these pre-attentional processes, especially regarding emotion regulation. This is also reflected by consistent increases in attention, awareness, decentering, and emotion regulation over diverse quantitative and qualitative measurements and in accordance with the initial motivations of better more presence, awareness, emotion regulation and stress handling. All participants at least informally incorporated mindfulness into their lives and, consistently, mindfulness understanding shifted from more theoretical to experiential perspectives, including well-being and real life. Stressors remained identical, but the way of dealing with them changed for all participants, suggesting that MHBP promotes stress management skills. Aberrant salience reductions might constitute a possible mechanism underlying the improvements in well-being and stress management, warranting better exploration in future studies. Declarations Ethics approval and consent to participate: This study was approved by the Research Ethics Committee of the University of Campinas (#93622718.0.0000.5404) and conducted in accordance with the 1964 Declaration of Helsinki. Participants provided written informed consent prior to participation. Funding: Marcelo Demarzo received the Research Productivity Grant (1D) from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The funding source had no involvement in the study design, data collection, analysis and interpretation, writing of the manuscript, and decision to submit the article for publication. Conflict of interest: The authors declare that they have no competing interest. Code availability: Not applicable. Author contributions: All authors contributed to the study conception and design. Júlia Paula Souza evaluated the health questionnaires, selected the participants, conducted the MBHP course, and transcribed the qualitative questionnaires. Isabel Wießner and Júlia Paula Souza collected, analyzed, and interpreted the data, created the tables, and wrote the first draft of the manuscript. Isabel Wießner created the figures. All authors read and approved the final manuscript. Data availability: The data is available upon reasonable request. 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Serretti, “Mindfulness-based stress reduction for stress management in healthy people: A review and meta-analysis,” J. Altern. Complement. Med., vol. 15, no. 5, pp. 593–600, 2009. R. M. Ryan and E. L. Deci, “ON HAPPINESS AND HUMAN POTENTIALS: A Review of Research on Hedonic and Eudaimonic Well-Being,” Annu. Meet. Natl. Acad. Neuropsychol., vol. 52, pp. 141–66, 2001. X. Wang, D. Zhang, and J. Wang, “Dual-Factor Model of Mental Health: Surpass the Traditional Mental Health Model,” Psychology, vol. 02, no. 08, pp. 767–772, 2011. M. A. Killingsworth and D. T. Gilbert, “A wandering mind is an unhappy mind,” Science (80-.)., vol. 330, no. 6006, p. 932, 2010. B. L. Fredrickson, “The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions.,” Am. Psychol., vol. 56, no. 3, pp. 218–226, 2001. K. Neff, “Self-compassion: An alternative conceptualization of a healthy attitude toward oneself,” Self identity, vol. 2, no. 2, pp. 85–101, 2003. S. L. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4528848","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317526488,"identity":"05ba43b2-dedd-41c8-87c6-d50d7a8f07b6","order_by":0,"name":"Isabel Wießner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYBACNjAqAJNgIAciDjwgqMUAocUYrCWBoEUGCF5iA4jEp4WP//CzBx8MGBL72Nsffy6ouJc+P+zwQ6AtdnK6DTiskEgzN5wB1NLGc8ZMesaZ4tyNt9MMgFqSjc0O4NLCYCbNY8CQ2yaRw8bM25aQu3F2AkjLgcRtuLTwH/8m/QekRf7548+8/xLSDWenf8CvhSHHTJoBbAuDgTRvQ0KCvHQOAVskcsoNewwk6tt4gHp5jiUYbpDOKTiQYIDbL/L9x7c9+FFhYyzffvzxZ56aBHn52embP3yosJPDpQUKJBBMA7BKAxwKsdvbQIrqUTAKRsEoGAkAAEQZWEMpn2gJAAAAAElFTkSuQmCC","orcid":"","institution":"State University of Campinas","correspondingAuthor":true,"prefix":"","firstName":"Isabel","middleName":"","lastName":"Wießner","suffix":""},{"id":317526489,"identity":"8ebc9236-c2f6-4174-8983-e36b1e3bffaa","order_by":1,"name":"Júlia Paula Souza","email":"","orcid":"","institution":"Federal University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Júlia","middleName":"Paula","lastName":"Souza","suffix":""},{"id":317526492,"identity":"c4abb0c6-5c6e-4be3-9f47-ecc8b7406465","order_by":2,"name":"Marcelo Demarzo","email":"","orcid":"","institution":"Federal University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Marcelo","middleName":"","lastName":"Demarzo","suffix":""},{"id":317526495,"identity":"5531d219-d0df-47a2-b9c7-0bd28eb9c13d","order_by":3,"name":"Luís Fernando Tófoli","email":"","orcid":"","institution":"State University of Campinas","correspondingAuthor":false,"prefix":"","firstName":"Luís","middleName":"Fernando","lastName":"Tófoli","suffix":""}],"badges":[],"createdAt":"2024-06-04 14:39:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4528848/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4528848/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59964471,"identity":"cf39a760-8219-48ad-8e31-8b9e1809b943","added_by":"auto","created_at":"2024-07-10 01:51:42","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":207951,"visible":true,"origin":"","legend":"\u003cp\u003eStudy design, measurements, and number of participants\u003cem\u003e. \u003c/em\u003eThe measurements were applied before (T0 in May 2019), immediately after (T1 in June 2019), and three months after the course (T2 in September 2019)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4528848/v1/8656b2233f098b946abd3ce3.jpeg"},{"id":59964470,"identity":"c819768c-69c9-465a-9674-81271edaa173","added_by":"auto","created_at":"2024-07-10 01:51:42","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":591624,"visible":true,"origin":"","legend":"\u003cp\u003eThe effects of mindfulness on pre-attentional and attentional processes and relationships between these effects. (a) The aberrant salience (ASI) factor Heightened Cognition was enhanced after the course compared to baseline, and Heightened Emotionality decreased in the long term compared to baseline. (b) Mindful attention and awareness (MAAS) and decentering (EQ) were increased in the short and long term, as compared to baseline. Attention and awareness continued to increase after the course compared to three months afterward. (c) Increased mindful attention (T1-T0 and T2-T0) correlated with decreased Heightened Emotionality (T2-T0). Displayed are (a) mean (±SEM) scores, (b) mean (±SEM) percentage of scale maximum, and (c) scatterplots for 21 subjects. *** \u003cem\u003ep\u003c/em\u003e≤ 0.001, * \u003cem\u003ep\u003c/em\u003e ≤ 0.05 (corrected), # \u003cem\u003ep\u003c/em\u003e ≤ 0.05 (uncorrected).\u003c/p\u003e\n\u003cp\u003eASI: Aberrant Salience Questionnaire; MAAS: Mindful Attention Awareness Scale; EQ: Experiences Questionnaire; T0: before the course; T1: after the course; T2: three months after the course; T1-T0: difference between after the course and baseline; T2-T0: difference between three months after the course and baseline\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4528848/v1/6738729229c635ed26836fc4.jpeg"},{"id":61066740,"identity":"dce470fe-0130-4c20-81ff-04b068ddc2d3","added_by":"auto","created_at":"2024-07-25 07:48:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1430385,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4528848/v1/8abae8e2-bd18-4e22-9b2b-596244639471.pdf"},{"id":59964469,"identity":"54e7dafb-d6f7-4741-81d0-6b443df486e5","added_by":"auto","created_at":"2024-07-10 01:51:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":47475,"visible":true,"origin":"","legend":"","description":"","filename":"ArticleMindfulness240419DPsuppl.docx","url":"https://assets-eu.researchsquare.com/files/rs-4528848/v1/751a04ffdad9578f20820e31.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mindfulness predicts reduced aberrant salience and improves stress management","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eMindfulness is the \u0026ldquo;awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment\u0026rdquo; [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, p.2]. Mindfulness research has considerably grown over the last forty years, showing benefits in cognitive functioning, well-being and health across clinical and non-clinical populations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It originates from Eastern contemplative traditions and was adapted to Western culture within Mindfulness-Based Stress Reduction (MBSR), a 10-week training program to aid patients with chronic pain [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMindfulness-Based Health Promotion (MBHP) is inspired by MBSR but adapted to the Brazilian context with has a shorter, 8-week duration; it stands out for its comprehensive approach to health promotion, unrestricted to specific pathologies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Accordingly, MBHP has shown benefits in diverse contexts and populations, such as improved anxiety and depression in police officers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], burnout symptoms in primary health care providers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], stress, resilience, and immune function in teachers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], muscular pain in nurses [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], and overweight in women [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the mechanisms driving the benefits of MBHP on health and well-being remain inadequately elucidated, with the long-term benefits of such interventions requiring further investigation. Additionally, there is a need for comprehensive studies to assess the feasibility and effectiveness of MBHP across diverse populations and various health outcomes.\u003c/p\u003e \u003cp\u003eMBHP is based on the key elements of attention, intention, and attitude [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It emphasizes the importance of conscious attention anchored in the present, the intention to remain focused, and the ability to redirect attention, along with Kabat-Zinn\u0026rsquo;s mindful attitudes. Both course concepts emphasize the development of attentive and receptive presence as the core of mindfulness practice. Accordingly, mindfulness practice is linked to changed attentional and pre-attentional processes, including attention, awareness, and decentering [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeyond that, mindfulness practices might influence pre-attentional processes such as salience. Salience is the prominence of a perceived element (e.g., an object or idea) that automatically catches attention, such as a red apple on a green tree. Salience is a fundamental adaptive mechanism for optimally interacting with our environment [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Mindfulness training reduces reward salience [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], first-person perspective salience [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and defensive responses to mortality salience [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Within the brain, mindfulness training increases the connectivity in the salience network [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, aberrant salience is the exaggerated assignment of importance to perceived elements. Originally, the concept has been proposed as mechanism underlying the symptoms in psychotic disorders [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Specifically, the work hypothesized that hallucinations and delusions are generated by a dysregulation and hyperdopaminergic state of the brain, promoting an aberrant attribution of salience to one\u0026rsquo;s experiences. In fact, aberrant salience has been associated with negative symptoms in schizophrenia and psychotic experiences in first-episode psychosis and healthy controls [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Moreover, aberrant salience predicts anomalous and paranormal experiences [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], is increased with LSD and cannabis use [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and mediates the development of schizotypal symptoms in cannabis users [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Mindfulness has shown beneficial effects in psychotic disorders, particularly on negative symptoms and symptom severity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], but the mechanisms underlying these benefits are largely unexplored and the impact of mindfulness on aberrant salience unknown.\u003c/p\u003e \u003cp\u003eConsidering the potential of mindfulness to improve diverse mental conditions, including psychotic disorders, and modulate attention and salience, in this pioneer research, we aimed to explore the feasibility of mindfulness to reduce aberrant salience in a pilot study. For a more comprehensive understanding of the mechanisms and context of such effects, we furthermore sought to identify changes in attention and decentering, motivations for enrolling in a MBHP course, practicing habits, learnings, and stress management in the short and long term.\u003c/p\u003e"},{"header":"2 Material and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design\u003c/h2\u003e \u003cp\u003eThis is a pre-post-intervention pilot study with a follow-up assessment to test the effects of mindfulness training on aberrant salience. We conducted an 8-week MBHP course at the cultural center of the University of Campinas, Brazil, with measurements immediately before the first session (T0), right after the last session (T1), and three months afterwards (T2). This study was approved by the university\u0026rsquo;s Research Ethics Committee (#93622718.0.0000.5404). The study design, measurements, and participant number are illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003eHealthy Portuguese-speaking adults were recruited to participate in a free MBHP course via announcements on the website of the university\u0026rsquo;s cultural center (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.casadolago.proec.unicamp.br\u003c/span\u003e\u003cspan address=\"https://www.casadolago.proec.unicamp.br\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Candidates attended an introductory lecture about MBHP and were invited to voluntarily also participate in the study. They completed a health evaluation questionnaire, screening for acute symptoms of psychiatric or organic disorders and personality disorders, as the course is typically not recommended for these conditions. All 22 candidates were selected, provided informed consent, and participated in the course and study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Mindfulness Intervention\u003c/h2\u003e \u003cp\u003eMBHP, similar to established mindfulness programs like MBSR, aims to foster awareness, the conscious recognition of internal (thoughts, emotions, sensations, impulses, behaviors) and external (activities, relationships, etc.) phenomena [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Through the cultivation of daily awareness, it aims to improve conscious decision-making and reduce reactivity. For this, MHBP promotes regular engagement in formal and informal mindfulness practice, focusing on attention, attitude, and intention.\u003c/p\u003e \u003cp\u003eThe MBHP protocol is an 8-week structured program comprising weekly 2-hour sessions to explore techniques and learn about full attention. The sixth session features contemplative silence, mirroring the silent retreats in MBSR programs but adapted for implementation in organizations and public services. Participants receive formal practices for daily exercise at home or work, lasting 15 min on average but up to 45 min for committed participants. They are also guided to conduct informal practices, using daily routines as opportunities to exercise full attention.\u003c/p\u003e \u003cp\u003eKey four techniques include mindful breathing, body scanning, mindful walking, and light mindful movements suitable for people with physical limitations. Attentional focus in mindful breathing is on the breath; in body scanning, on sensations throughout the body; and in walking and movements, on the moving body. Additional techniques include practices with compassion, self-compassion, sounds, thoughts, open monitoring, and the three steps (body perception ‒ respiration ‒ body perception). Psychoeducational dynamics include \u0026ldquo;primary and secondary suffering\u0026rdquo; and \u0026ldquo;hello, thank you, goodbye\u0026rdquo; and aim to facilitate understanding the meditative practices [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Measurements\u003c/h2\u003e \u003cp\u003eBeyond our primary focus on aberrant salience, we incorporated both quantitative and qualitative measurements as secondary outcomes for a comprehensive understanding of attentional processes, learnings, and motivations related to mindfulness training. Measurements were conducted by pen and paper (T0, T1), and online (T2).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Primary Outcomes\u003c/h2\u003e \u003cp\u003eThe Aberrant Salience Inventory (ASI) assesses the aberrant salience trait through 29 yes-no questions and five factors (Increased Significance; Senses Sharpening; Impending Understanding; Heightened Emotionality; Heightened Cognition) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Each factor measures a unique aspect of the construct: Increased Significance evaluates the excessive importance attributed to trivial events; Senses Sharpening reflects an intensified sensory perception; Impending Understanding captures a feeling of being on the brink of an important revelation; Heightened Emotionality involves stronger emotional reactions to everyday stimuli; Heightened Cognition reflects the feeling of being part of something important. The English scale was translated into Brazilian Portuguese by our team; validation is in progress.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Secondary Outcomes\u003c/h2\u003e \u003cp\u003eQuantitatively, mindfulness skills were examined repeatedly by the Mindful Attention Awareness Scale (MAAS) measuring mindful attention and awareness by 15 items on a 6-point Likert scale (1\u0026thinsp;=\u0026thinsp;almost always; 6\u0026thinsp;=\u0026thinsp;almost never) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The Experiences Questionnaire (EQ) measures decentering by 20 items on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;never; 5\u0026thinsp;=\u0026thinsp;always) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The Brazilian version\u0026rsquo;s single-factor structure has been confirmed, although findings are yet to be published (P. Lucena-Santos, personal communication, 29 June 2020).\u003c/p\u003e \u003cp\u003eQualitatively, open-ended questionnaires examined primary motivations for seeking the course and the subjective understanding of mindfulness (T0), key learnings and preferred practices (T1, T2), and main stressors and coping mechanisms (T0, T1, T2) (the complete questionnaires are provided in the Supplementary Methods). Paper-based questionnaires were subsequently transcribed. The data were interpreted by a Content Analysis, comprising three phases of pre-analysis (research corpus), analytical description, and final analysis [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Statistical Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were analyzed using IBM SPSS Statistics (version 22). A repeated measures General Linear Model (GLM\u003csub\u003erep\u003c/sub\u003e) with \u0026lsquo;time\u0026rsquo; (T0, T1, T2) as a within-subjects factor was used for MAAS and EQ. For the ASI, the GLM\u003csub\u003erep\u003c/sub\u003e included an additional within-subject factor \u0026lsquo;scale factor\u0026rsquo;. Main effects of time were examined, followed by pairwise comparisons for each factor and time point. Effect sizes were estimated using partial eta squared (\u003cem\u003eη\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e). Spearman\u0026rsquo;s rank correlations (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e) were calculated between time-dependent changes for pre-post (T1-T0), pre-follow-up (T2-T0), and post-follow-up (T2-T1) intervals. Significance threshold was set at α\u0026thinsp;=\u0026thinsp;0.05, two-tailed. All \u003cem\u003ep\u003c/em\u003e-values were Bonferroni-corrected \u003cem\u003epost hoc\u003c/em\u003e for multiple comparisons.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Participants\u003c/h2\u003e \u003cp\u003eDuring the course, one participant withdrew for personal reasons, leaving 21 participants for final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the demographic characteristics of the participants who completed the study. Participants were predominantly female, middle-aged, in a partnership, and highly educated.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the final sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003estudy completed\u003c/p\u003e \u003cp\u003estudy not completed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (95.5%)\u003c/p\u003e \u003cp\u003e1 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyears (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.8; 23‒73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (76.2%)\u003c/p\u003e \u003cp\u003e5 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esingle\u003c/p\u003e \u003cp\u003emarried/in partnership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (38.1%)\u003c/p\u003e \u003cp\u003e13 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyears (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2; 15‒30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003etherapist/psychologist\u003c/p\u003e \u003cp\u003eprofessor/teacher\u003c/p\u003e \u003cp\u003estudent\u003c/p\u003e \u003cp\u003estatisticians/system analysts\u003c/p\u003e \u003cp\u003ebiologist/chemists\u003c/p\u003e \u003cp\u003eentrepreneur\u003c/p\u003e \u003cp\u003ephysician/nurse\u003c/p\u003e \u003cp\u003ehousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (19.0%)\u003c/p\u003e \u003cp\u003e3 (14.3%)\u003c/p\u003e \u003cp\u003e5 (23.8%)\u003c/p\u003e \u003cp\u003e3 (14.3%)\u003c/p\u003e \u003cp\u003e2 (9.5%)\u003c/p\u003e \u003cp\u003e1 (4.8%)\u003c/p\u003e \u003cp\u003e2 (9.5%)\u003c/p\u003e \u003cp\u003e1 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Characteristics were assessed by self-reports.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Primary Outcomes\u003c/h2\u003e \u003cp\u003eRegarding aberrant salience, there was a main effect of time in ASI for the quadratic, but not linear, within-subjects contrast (\u003cem\u003eF\u003c/em\u003e(1,20)\u0026thinsp;=\u0026thinsp;7.7, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011, \u003cem\u003eh\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e = 0.28), implying that mindfulness training was related to non-linear alterations in aberrant salience. Pairwise comparisons demonstrated increased Heightened Cognition at T1 compared to T0 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), decreased Heightened Emotionality at T2 compared to T0 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.019), and decreased Total at T2 compared to T1 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042). Moreover, there were increases in Senses Sharpening at T1 compared to T0 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031) and decreases in Heightened Emotionality (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033) and Heightened Cognition at T2 compared to T1 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.031), but these effects did not survive correction for multiple testing (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003eMindfulness increased over time (see 3.3. Secondary Outcomes, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB) which was related to reduced aberrant salience, as reflected by negative correlations between MAAS (T1-T0 and T2-T0) and ASI Heightened Emotionality (T2-T0) (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e = -0.64, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.020 and \u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e = -0.64, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023). Overall, this indicates that mindful attention gains might predict and promote long-term reductions in emotional aberrant salience (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eASI: Aberrant Salience Questionnaire; MAAS: Mindful Attention Awareness Scale; EQ: Experiences Questionnaire; T0: before the course; T1: after the course; T2: three months after the course; T1-T0: difference between after the course and baseline; T2-T0: difference between three months after the course and baseline\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Secondary Outcomes\u003c/h2\u003e \u003cp\u003eQuantitatively, mindfulness-related skills improved over time with main effects for MAAS (\u003cem\u003eF\u003c/em\u003e(1,20)\u0026thinsp;=\u0026thinsp;80.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eh\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e = 0.80) and EQ (\u003cem\u003eF\u003c/em\u003e(1,20)\u0026thinsp;=\u0026thinsp;40.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, \u003cem\u003eh\u003c/em\u003e\u003csub\u003e\u003cem\u003ep\u003c/em\u003e\u003c/sub\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e = 0.67). Pairwise comparisons revealed increases in MAAS and EQ at T1 and T2, compared to T0, respectively (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This suggests that mindfulness training promoted short- and long-term mindful attention, awareness, and decentering. Moreover, MAAS was increased at T2 compared to T1 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.025), indicating continuing enhancements in attention and awareness after the course\u0026rsquo;s conclusion up to three months (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB). As for correlations, MAAS (T1-T0) correlated highly positively with MAAS (T2-T0) (\u003cem\u003er\u003c/em\u003e\u003csub\u003e\u003cem\u003es\u003c/em\u003e\u003c/sub\u003e = 0.80, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating that attention enhancements during the course might predict enhancements three months later.\u003c/p\u003e \u003cp\u003eQualitatively, a detailed description on the creation of categories within motivations, course meaning, learnings, preferred practices, mindfulness understanding, stressors, and stress management related to MBHP participation is provided in the Supplementary Results. This includes also a rich dataset of verbatim quote examples. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e resumes the categories and distributions for these measurements.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMotivations, course meaning, learnings, preferred and continued practices, mindfulness understanding, stressors, and stress management related to Mindfulness-Based Health Promotion (MBHP) before the course (T0), immediately afterwards (T1), and three months afterwards (T2)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasurement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime point\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCount (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStress reduction and emotional regulation\u003c/p\u003e \u003cp\u003eGreater presence, awareness, and well-being\u003c/p\u003e \u003cp\u003eSelf-awareness, self-care, and self-development\u003c/p\u003e \u003cp\u003eEnhanced concentration, focus, and attention\u003c/p\u003e \u003cp\u003eJoin a group for practice:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (34%)\u003c/p\u003e \u003cp\u003e13 (22%)\u003c/p\u003e \u003cp\u003e11 (19%)\u003c/p\u003e \u003cp\u003e8 (14%)\u003c/p\u003e \u003cp\u003e6 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse meaning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePause, self-awareness, and self-care\u003c/p\u003e \u003cp\u003eWell-being\u003c/p\u003e \u003cp\u003eRestart, a new way of life\u003c/p\u003e \u003cp\u003eSelf-development\u003c/p\u003e \u003cp\u003eImprovement in relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (34%)\u003c/p\u003e \u003cp\u003e11 (18%)\u003c/p\u003e \u003cp\u003e10 (16%)\u003c/p\u003e \u003cp\u003e10 (16%)\u003c/p\u003e \u003cp\u003e9 (14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLearnings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGreater presence, awareness, and well-being\u003c/p\u003e \u003cp\u003eSelf-compassion and compassion\u003c/p\u003e \u003cp\u003eAcceptance, kindness, and care\u003c/p\u003e \u003cp\u003eReduced rumination and expanded perspective\u003c/p\u003e \u003cp\u003ePrimary and secondary suffering\u003c/p\u003e \u003cp\u003eImportance of the group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (30%)\u003c/p\u003e \u003cp\u003e15 (21%)\u003c/p\u003e \u003cp\u003e14 (20%)\u003c/p\u003e \u003cp\u003e12 (17%)\u003c/p\u003e \u003cp\u003e5 (7%)\u003c/p\u003e \u003cp\u003e3 (4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncreased awareness and well-being\u003c/p\u003e \u003cp\u003eSelf-perception and broadened perspective\u003c/p\u003e \u003cp\u003eSelf-compassion and compassion\u003c/p\u003e \u003cp\u003eIncreased concentration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (39%)\u003c/p\u003e \u003cp\u003e7 (25%)\u003c/p\u003e \u003cp\u003e6 (21%)\u003c/p\u003e \u003cp\u003e5 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePreferred practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBreathing\u003c/p\u003e \u003cp\u003eThree steps\u003c/p\u003e \u003cp\u003eSounds and thoughts\u003c/p\u003e \u003cp\u003eBody scanning\u003c/p\u003e \u003cp\u003eWalking\u003c/p\u003e \u003cp\u003eSelf-compassion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (28%)\u003c/p\u003e \u003cp\u003e8 (20%)\u003c/p\u003e \u003cp\u003e7 (18%)\u003c/p\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003cp\u003e4 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBreathing\u003c/p\u003e \u003cp\u003eSounds and thoughts\u003c/p\u003e \u003cp\u003eThree steps\u003c/p\u003e \u003cp\u003eSelf-compassion and compassion\u003c/p\u003e \u003cp\u003eBody scanning\u003c/p\u003e \u003cp\u003eWalking\u003c/p\u003e \u003cp\u003eMindful eating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (26%)\u003c/p\u003e \u003cp\u003e9 (23%)\u003c/p\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003cp\u003e5 (13%)\u003c/p\u003e \u003cp\u003e4 (11%)\u003c/p\u003e \u003cp\u003e3 (8%)\u003c/p\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice continuation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003econtinue formally\u003c/p\u003e \u003cp\u003econtinue informally/do not continue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (76%)\u003c/p\u003e \u003cp\u003e5 (23%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emin/week (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.4\u0026thinsp;\u0026plusmn;\u0026thinsp;49.5; 0‒210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMindfulness understanding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiving with presence\u003c/p\u003e \u003cp\u003eMeditation technique\u003c/p\u003e \u003cp\u003eBeginner\u0026rsquo;s mind, non-judgment, acceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (52%)\u003c/p\u003e \u003cp\u003e9 (24%)\u003c/p\u003e \u003cp\u003e8 (21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAwareness, presence\u003c/p\u003e \u003cp\u003eAcceptance, real life\u003c/p\u003e \u003cp\u003eWell-being, peace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (40%)\u003c/p\u003e \u003cp\u003e14 (34%)\u003c/p\u003e \u003cp\u003e11 (27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePresence, awareness\u003c/p\u003e \u003cp\u003eWell-being\u003c/p\u003e \u003cp\u003eAcceptance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (48%)\u003c/p\u003e \u003cp\u003e11 (38%)\u003c/p\u003e \u003cp\u003e4 (14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStressor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWork\u003c/p\u003e \u003cp\u003eRelationships\u003c/p\u003e \u003cp\u003eHealth issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (46%)\u003c/p\u003e \u003cp\u003e17 (44%)\u003c/p\u003e \u003cp\u003e4 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWork\u003c/p\u003e \u003cp\u003eRelationships\u003c/p\u003e \u003cp\u003eHealth issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (43%)\u003c/p\u003e \u003cp\u003e5 (42%)\u003c/p\u003e \u003cp\u003e3 (21%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWork\u003c/p\u003e \u003cp\u003eRelationships\u003c/p\u003e \u003cp\u003eHealth issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (61%)\u003c/p\u003e \u003cp\u003e4 (22%)\u003c/p\u003e \u003cp\u003e3 (17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStress management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of resources\u003c/p\u003e \u003cp\u003eAnxiety, fatigue\u003c/p\u003e \u003cp\u003eLow self-esteem, discouragement, self-demand\u003c/p\u003e \u003cp\u003eTask procrastination\u003c/p\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (35%)\u003c/p\u003e \u003cp\u003e13 (33%)\u003c/p\u003e \u003cp\u003e7 (18%)\u003c/p\u003e \u003cp\u003e3 (8%)\u003c/p\u003e \u003cp\u003e3 (8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReduced automatic reactions, increased reflection, and choice\u003c/p\u003e \u003cp\u003eIncreased tranquility and calmness\u003c/p\u003e \u003cp\u003eAcceptance\u003c/p\u003e \u003cp\u003eImprovement in relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (29%)\u003c/p\u003e \u003cp\u003e15 (29%)\u003c/p\u003e \u003cp\u003e12 (24%)\u003c/p\u003e \u003cp\u003e9 (18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSelf-perception, broadened perspective\u003c/p\u003e \u003cp\u003ePause\u003c/p\u003e \u003cp\u003eBreathing, body-awareness\u003c/p\u003e \u003cp\u003eAcceptance, non-judgment, trust, patience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (29%)\u003c/p\u003e \u003cp\u003e11 (27%)\u003c/p\u003e \u003cp\u003e9 (22%)\u003c/p\u003e \u003cp\u003e9 (22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMotivations (T0) for seeking MBHP predominantly included tools for stress coping, emotion regulation, more presence, and well-being, but also self-care and development, concentration, and attention. Some individuals with meditation experience wished to find a group to continue their practices.\u003c/p\u003e \u003cp\u003eAccordingly, most participants experienced the course (T1) as an opportunity for pause, well-being, self-care, and -development, as reflected in the statement: \u0026ldquo;This course represented a commitment I made to take better care of myself\u0026rdquo; (P18). Similarly, important learnings comprised awareness, well-being, and (self-)compassion (T1, T2), but also acceptance, kindness, reduced rumination (T1), self-perception, and broadened perspective (T2). Moreover, motivations and learnings reflected the perceived meaning of mindfulness overall as presence and acceptance (T0-T2), but also awareness and well-being after participation (T1, T2).\u003c/p\u003e \u003cp\u003ePreferred practices were similar at T1 and T2, including breathing, three minutes, and sounds and thoughts, but also body scanning, walking, and self-compassion. Most participants practiced formally (~\u0026thinsp;46 min/week) and all participants practiced informally after three months.\u003c/p\u003e \u003cp\u003eStressors remained consistent with participants highlighting work, relationships, and health issues (T0-T2). \u0026ldquo;Work\u0026rdquo; was interpreted broadly, including excessive professional demands and pressure, job instability, appropriate remuneration, balancing job responsibilities with household and childcare, and professional fulfillment. \u0026ldquo;Relationships\u0026rdquo; encompassed factors like the end of long-term relationships and general misunderstandings, from close family ties to casual interactions (e.g. with strangers in traffic). \u0026ldquo;Health issues\u0026rdquo; included personal problems (e.g., phobias) or caring for a sick parent.\u003c/p\u003e \u003cp\u003eRegarding stress management, participants first mainly reported lacking resources to handle stress (T0). They described anxiety, fatigue, issues of self-esteem, and self-demand, which might have derived from this perceived deficiency, as illustrated by the statements: \u0026ldquo;I haven\u0026rsquo;t been able to cope and everything seems to be piling up in my mind without a peaceful solution\u0026rdquo; (P21) and \u0026ldquo;I feel like a \u0026lsquo;bomb\u0026rsquo; could go off at any moment\u0026rdquo; (P5). After the course, all participants reported shifts in stress management, with an enhanced capacity for reflection, choice, and calmness as stated here: \u0026ldquo;My automatic reactions have greatly diminished. My ability to reflect has increased.\u0026rdquo; (P2) and \u0026ldquo;Lately, the most significant stressor is my 2-year-old\u0026rsquo;s tantrums. I\u0026rsquo;ve been trying to pause, become aware of my breathing, body, the sensations... I distance myself briefly until calm and then resume\u0026rdquo; (P1).\u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis is the first study, to the best of our knowledge, to explore the interaction between mindfulness and aberrant salience. After the 8-week course, total aberrant salience and the factor Heightened Emotionality decreased, while mindful attention and decentering increased over time. Correlations suggest that increased mindful attention post-course predicts decreased Heightened Emotionality after three months. Moreover, mindfulness and aberrant salience decreases were correlated after three months.\u003c/p\u003e \u003cp\u003eBeyond that, our qualitative results indicated that motivations of stress reduction, emotion regulation, awareness, well-being, and self-care mostly matched the perceived course meaning, learnings, and mindfulness understanding short- and long-term. Most participants continued practicing formally and showed similar preferred practices over time. While stressors remained stable, their coping changed from self-reported lack of resources and negative implications to more controlled, reflective decisions, tranquility, and acceptance short- and long-term.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Mindfulness, Attention and Aberrant Salience\u003c/h2\u003e \u003cp\u003eMindfulness training seemed to exert contrasting effects on aberrant salience. The factor Heightened Cognition was increased after the course. This is not surprising, considering that this factor was conceptualized as the feeling of being part of something mystically, spiritually, or intellectually important, of approaching true awareness and understanding [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, Senses Sharpening (improved sensory perception and awareness) was tendentially increased post-course but not after three months, suggesting that MBHP might promote transitorily but not enduringly perceived improved sensorics, highlighting the contrast to psychotic-related phenomena [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Notably, aberrant salience was measured immediately after the last class (T1), in contrast to T0 (before the first class) and T2 (without any class). This may indicate that the just-finished class, rather than the overall 8-week course, could have impacted these outcomes, reinforcing the immediate, transient nature of effects. This aligns with tendentially reduced Heightened Cognition at T2 compared to T1, pointing to a reversion to baseline.\u003c/p\u003e \u003cp\u003eConversely, total aberrant salience decreased long-term compared to post-course, and Heightened Emotionality decreased long-term compared to baseline. These findings could suggest a dampening impact of MBHP and continued practice on aberrant salience, particularly regarding the processing of aberrant, confusing, overwhelming, and negative emotions [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This is in line with consistent reports of mindfulness promoting emotion regulation, emotional well-being, and health [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Notably, short- and long-term mindful attention correlated negatively with long-term Heightened Emotionality. This indicates that attention and awareness might constitute important mechanisms for emotional aberrant salience, with post-course mindful improvements predicting and long-term mindful improvements mirroring emotional improvements. Similarly, previous research reported baseline awareness to predict greater positive and lower negative affect after MBSR [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], underlining the importance of mindful awareness for emotion regulation.\u003c/p\u003e \u003cp\u003eAs expected, mindful attention and awareness were enhanced post-course and continued to rise three months afterward, probably related to continued practice. This aligns with the notion of attention and awareness being core aspects of mindfulness and consistent findings of mindfulness improving diverse attentional processes, including generalized attention, alerting, executive control, inhibition [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and meta-awareness, the awareness of experiencing internal processes like sensations, thoughts, and emotions [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Similarly, decentering was increased in the short and long term. Decentering is the \u0026ldquo;ability to observe one\u0026rsquo;s thoughts and feelings as temporary, objective events in the mind\u0026rdquo; [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, p.1], closely related to meta-awareness, robustly increased by mindfulness practices, and related to improved well-being and mental health [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Interestingly, the correlations between increased attention after MBHP and increased attention after three months, together with the continued practices, might suggest that course performance might predict long-term mindful capacity gains.\u003c/p\u003e \u003cp\u003eOverall, our results suggest that mindfulness training may influence diverse attentional processes, including pre-attentive salience, mindful attention, awareness, and decentering. While guided group practices enhanced the vague sense of belonging to something important (Heightened Cognition), continuous, individual practice reduced aberrant salience and overwhelming negative emotionality (Heightened Emotionality), which was predicted by and related to mindfulness improvements. These correlations emphasize the notion of mindful attention exerting strong influence on aberrant salience, at least regarding its emotional aspects. Aberrant salience, a concept from psychosis research to understand the mechanisms of psychotic experiences and increased by psychedelics [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], might therefore provide an intriguing new perspective on understanding the effects of mindfulness on pre-attentional processing. Beyond that, considering that mindfulness has been proposed as efficient adjunct for pharmacotherapy in psychosis [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], our results encourage its further investigation as complementary treatment approach, particularly for emotional distress in patients with psychotic disorders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Motivations, Learnings, and Stress Management\u003c/h2\u003e \u003cp\u003eThe qualitative findings indicate a primary motivation to join MBHP of finding tools for \u003cem\u003estress reduction and emotion regulation\u003c/em\u003e. This aligns with the objectives of the inaugural mindfulness program and its efficacy in alleviating stress and anxiety [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Such findings underscore that the allure of mindfulness courses remains today, notably, within our Brazilian sample.\u003c/p\u003e \u003cp\u003eOther predominant motivations were \u003cem\u003epresence, awareness, and well-being\u003c/em\u003e, alongside \u003cem\u003eself-awareness, self-care, and self-development\u003c/em\u003e, indicating aspirations for a holistic sense of well-being beyond stress alleviation. This aligns with the notion of well-being as a multifaceted phenomenon beyond the mere absence of psychopathology, encompassing diverse factors such as cultural nuances, socioeconomic factors, health status, quality of intra- and interpersonal relationships, and psychological processes, and personal growth [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBeyond the strong pursuit of emotional balance and holistic well-being, the wish to enhance \u003cem\u003econcentration, focus, and attention\u003c/em\u003e emerged less often. This was unexpected since attention training is a core aspect of mindfulness practices [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This may be attributed to Brazil\u0026rsquo;s demanding reality at that time, as described in the following: \u0026ldquo;In Brazil, the current government\u0026rsquo;s political landscape has become a major stressor, especially for those of us in public education. Dealing with this stressor has been increasingly difficult\u0026rdquo; (P8). \u0026ldquo;A stressor for me is being in temporary employment and uncertain about my professional path after this period. The country\u0026rsquo;s political, economic, and ethical instability, directly impacting my work environment (academic research), is concerning\u0026rdquo; (P2). This may also be an explanation for why \u0026ldquo;work\u0026rdquo; remained the main stressor over time.\u003c/p\u003e \u003cp\u003eRegarding learning, most participants reported greater \u003cem\u003epresence, awareness, and well-being\u003c/em\u003e in the short and long term, according to their initial motivations. The concurrent appearance of higher awareness and well-being corroborates with findings linking awareness with happiness and well-being [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Greater awareness of thoughts and feelings might have contributed to the expanded perspectives preventing participants from being overwhelmed, thereby promoting well-being, aligning with the Broaden-and-Build Theory of Positive Emotions [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, many reported \u003cem\u003eacceptance, kindness, and care\u003c/em\u003e, beyond \u003cem\u003ecompassion and self-compassion\u003c/em\u003e. These mindfulness qualities have been described to encompass the understanding that suffering exists in every person but does not need to define them; instead, one can acknowledge its common experience and offer kindness rather than self-judgment [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. The alignments of these notions with the course learnings support its efficacy. The endurance of these learnings up to three months may be attributed to the continued formal and informal practices, integrating mindfulness into everyday life.\u003c/p\u003e \u003cp\u003eAccording to the motivations and learnings, the course meaning was described afterward as an opportunity for \u003cem\u003epause\u003c/em\u003e, \u003cem\u003eself-care\u003c/em\u003e, and \u003cem\u003ewell-being\u003c/em\u003e, but also a \u003cem\u003enew way of living\u003c/em\u003e, as eloquently described here: \u0026ldquo;a door that opened to a more colorful, intense, and meaningful life\u0026rdquo; (P2). This is consistent with MBHP\u0026rsquo;s objective to trigger a new, mindful way of life [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and aligns with all participants continuing to practice informally after three months, most of them even formally. The preferred \u003cem\u003epractices\u003c/em\u003e varied according to the individual life moments of the participants, as expected within dynamic and continuous learning processes. Nevertheless, they showed remarkable similarities at T1 and T2, with breathing, three steps, and sounds and thoughts as favorites, followed by body scanning, walking, and self-compassion.\u003c/p\u003e \u003cp\u003eRegarding the \u003cem\u003emeaning of mindfulness\u003c/em\u003e, in the beginning, participants demonstrated technical knowledge, distinguishing between formal and informal practice and some mindful attitudes, such as presence and non-judgment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. After the course, responses seemed to shift from technical to experiential, including \u003cem\u003ereal life\u003c/em\u003e, \u003cem\u003ewell-being\u003c/em\u003e, and \u003cem\u003epeace\u003c/em\u003e, suggesting that rationalizing mindfulness provides just one facet of experiencing and practicing it.\u003c/p\u003e \u003cp\u003eAlthough the \u003cem\u003estressors\u003c/em\u003e of work, relationships, and health issues remained constant over the whole time, participants changed their way of dealing with them. First, they lacked resources and responded with anxiety, fatigue, and discouragement. In short and long term, they highlighted increased reflection, perception, tranquility, and acceptance, among others. This is reflected, for example, in reports on increased awareness of internal contents and processes: \u0026ldquo;When I have intense thoughts of self-criticism and self-demand, I can perceive that they are not real, accept myself more as I am, and show self-compassion by recognizing my limitations\u0026rdquo; (P13). This may indicate that MBHP and continuous practice affected the mental capacities for handling stressors, allowing for more awareness and emotional regulation. This aligns with MBHP\u0026rsquo;s main objective of stress reduction by decreasing automatic reactions and increasing conscious decision-making [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For this, participants are guided that nothing needs to be achieved and everything that arises can be accepted and embraced, aligning with the notion that reduced resistance to the mind\u0026rsquo;s contents diminishes suffering [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Synthesizing Primary and Secondary Outcomes\u003c/h2\u003e \u003cp\u003eA hitherto unexplored process in mindfulness research is \u003cem\u003eaberrant salience\u003c/em\u003e. Most prominently, we found increased \u003cem\u003eHeightened Cognition\u003c/em\u003e (sense of achieving a deeper understanding and being part of something spiritually or intellectually important). It was enhanced after the course despite its secular nature and focus on attention training. This increase may also be reflected in simultaneous qualitative reports of a new way of living, self-development (course meaning), expanded perspective, awareness, presence (learning, mindfulness understanding), and reflection (stress management), as described here: \u0026ldquo;I feel like a portal of knowledge has opened, about better ways of living and perceiving time, events, my own emotions and thoughts\u0026rdquo; (P2), \u0026ldquo;It was a watershed in the perception of thoughts and emotions, it gave me tools to experience the present\u0026rdquo; (P1) and \u0026ldquo;It represented an incredible experience of being able to observe my interior, my thoughts, my desires\u0026rdquo; (P22). The transient Heightened Cognition increases might have been promoted by the group setting, considering that group importance (learnings) and improved relationships (stress management) were highlighted at T1 but not T2, in line with previous findings of advantages of group to solitary meditation [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eContrastingly, we discovered reduced total aberrant salience (T2 compared to T1). This might be reflected in reports as: \u0026ldquo;I can identify more clarity in situations where I previously let myself be dominated by thoughts and feelings\u0026rdquo; (P6) and \u0026ldquo;I feel more attentive to the fact that I do things by living them, perceiving them\u0026rdquo; (P21). The reduced aberrant salience seemed principally attributable to the reduced \u003cem\u003eHeightened Emotionality\u003c/em\u003e (confused, overwhelming, or negative emotional processing). Decreased Heightened Emotionality is echoed in qualitative findings on more well-being, compassion (learning, mindfulness understanding), self-perception, capacity for pause, and patience (stress management), suggesting diminished overwhelming sensations and more balanced emotion processing.\u003c/p\u003e \u003cp\u003eSimilarly, the quantitative rises in \u003cem\u003edecentering\u003c/em\u003e (T1 and T2) dovetails with qualitative reports of more self-development (motivations T0, course meaning T1), self-perception, broadened perspectives (learning T1 and T2, stress management T2), and detachment from emotions and thoughts, as observed here: \u0026ldquo;This course represented for me a discovery that observing thoughts and directing their course is possible\u0026rdquo; (P4) and \u0026ldquo;I noticed a difference, especially concerning negative thoughts. I realized that they do not define me\u0026rdquo; (P10). This combines with the notion of mindfulness enhancing emotion regulation, positive emotions, and self-compassion, and reducing negative emotions, which relates to improved mental health, stress, and depression [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterestingly, mindful \u003cem\u003eawareness and attention\u003c/em\u003e were key aspects in motivations, learning, course meaning, and mindfulness understanding. These included more presence and concentration (learning and mindfulness understanding T1 and T2), self-awareness (course meaning T1), awareness of internal processes, reflection, conscious decision-making, and self-awareness (stress management T1 and T2), suggesting that the initial objectives were met. These qualitative reports were accompanied by quantitative increases in mindful attention and awareness throughout the study, with post-course predicting long-term improvements. This points to the consistency of our findings and an overall robust phenomenon, aligning with the importance of attention and awareness in mindfulness practices [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImportantly, the correlations between short- and long-term attention and awareness with long-term decreased Heightened Emotionality might point to mechanisms underlying these aberrant salience reductions, suggesting the potential feasibility of attentional training to alter pre-attentional emotional and perceptional mechanisms, as mirrored in this statement: \u0026ldquo;Today it really means full attention to what you do, no matter how insignificant the action seems to me. It's the de-automatization of everything you do, it's living in a dynamic way so you can understand the world around you\u0026rdquo; (P21). Overall, this relationship might pinpoint a potential therapeutic mechanism in patients with psychotic disorders [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], warranting further investigation.\u003c/p\u003e \u003cp\u003eAccording to the motivations of reduced stress and better emotion regulation, all participants reported improved \u003cem\u003estress management\u003c/em\u003e capacities. With initial deficiencies, they reported reduced automatic responses, enhanced reflections, choices, and calmness (T1), and enhanced self-awareness, perspective, and reflection (T2). The qualitative and quantitative enhancements in attention, awareness, and decentering point to possible mechanisms underlying these changes. Awareness, attention, presence, and acceptance can contribute to de-automatization, increasing self-control and well-being [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], potentially accounting for our reduced automatic reactions (stress management) and improved well-being (learning, course meaning, and mindfulness understanding). Similarly, decentering may promote reduced distress and emotional reactivity and increased well-being and mental health [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, our findings might suggest cognitive mechanisms of improved attention, awareness, decentering and potentially aberrant salience underlying mindfulness-induced improved stress management. Future research should better explore the connection between aberrant salience, emotion regulation and stress management.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Limitations\u003c/h2\u003e \u003cp\u003eWe used baseline comparisons and no placebo control, which means placebo and carryover effects cannot be ruled out. Furthermore, the T1 measurements may be disproportionately influenced by the last class shortly before, compared to T0 (before the first class) and T2 (without class), potentially amplifying the effects, particularly regarding Heightened Cognition (ASI). Moreover, the small and non-representative sample, being predominantly female and highly educated, might have influenced measurements such as motivations, learnings, and stressors. Relationships between changes in stress management and mindful attention and aberrant salience remain uncertain since stress management was not assessed quantitatively. Future studies should assess these quantitatively in a more rigorous, controlled, randomized design.\u003c/p\u003e \u003c/div\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis pilot study investigated the feasibility of mindfulness to reduce aberrant salience in the short and long term. We also aimed to explore related attentional processes, motivations, learnings, and stress management. Overall, mindfulness seemed to decrease aberrant salience, with correlations pointing to a crucial role of mindful attention for improving these pre-attentional processes, especially regarding emotion regulation. This is also reflected by consistent increases in attention, awareness, decentering, and emotion regulation over diverse quantitative and qualitative measurements and in accordance with the initial motivations of better more presence, awareness, emotion regulation and stress handling.\u003c/p\u003e \u003cp\u003e All participants at least informally incorporated mindfulness into their lives and, consistently, mindfulness understanding shifted from more theoretical to experiential perspectives, including well-being and real life. Stressors remained identical, but the way of dealing with them changed for all participants, suggesting that MHBP promotes stress management skills. Aberrant salience reductions might constitute a possible mechanism underlying the improvements in well-being and stress management, warranting better exploration in future studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate:\u003c/em\u003e This study was approved by the Research Ethics Committee of the University of Campinas (#93622718.0.0000.5404) and conducted in accordance with the 1964 Declaration of Helsinki.\u0026nbsp;Participants provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding:\u0026nbsp;\u003c/em\u003eMarcelo Demarzo received the Research Productivity Grant (1D) from the Conselho Nacional de Desenvolvimento Cient\u0026iacute;fico e Tecnol\u0026oacute;gico (CNPq). The funding source had no involvement in the study design, data collection, analysis and interpretation, writing of the manuscript, and decision to submit the article for publication.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConflict of interest:\u003c/em\u003e The authors declare that they have no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCode availability:\u0026nbsp;\u003c/em\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthor contributions:\u003c/em\u003e All authors contributed to the study conception and design. J\u0026uacute;lia Paula Souza evaluated the health questionnaires, selected the participants, conducted the MBHP course, and transcribed the qualitative questionnaires. Isabel Wie\u0026szlig;ner and J\u0026uacute;lia Paula Souza collected, analyzed, and interpreted the data, created the tables, and wrote the first draft of the manuscript. Isabel Wie\u0026szlig;ner created the figures. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData availability:\u003c/em\u003e The data is available upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the administration of university\u0026rsquo;s cultural center Casa do Lago for providing the space, the ethics committee for their trust, and, most importantly, we extend our gratitude to all participants.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJ. Kabat-Zinn, \u0026ldquo;Mindfulness-based interventions in context: Past, present, and future,\u0026rdquo; Clin. Psychol. Sci. Pract., vol. 10, no. 2, pp. 144\u0026ndash;156, 2003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG. F. Ferreira and M. 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Psychol.\u003c/em\u003e, vol. 4, no. MAY, pp. 1\u0026ndash;12, 2013.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mindfulness, Mindfulness-Based Health Promotion, aberrant salience, attention, awareness, motivations, learnings, stress management, psychosis","lastPublishedDoi":"10.21203/rs.3.rs-4528848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4528848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMindfulness can improve mental health and clinical conditions including psychosis, and modulate attentional processes including salience, an automatic mechanism to guide attention towards outstanding elements or ideas. Aberrant salience, the exaggerated assignment of salience, is associated with psychotic experiences, but the effects of mindfulness on aberrant salience are unexplored. To address this, we conducted a pre-post-intervention pilot study, with 21 participants undergoing an 8-week course of Mindfulness-Based Health Promotion (MBHP). Quantitative and qualitative measurements were conducted before (T0), immediately after (T1), and three months after the course (T2). Primary outcome was aberrant salience (Aberrant Salience Inventory, ASI). Secondary outcomes included quantitative scales on mindful attention (Mindful Attention Awareness Scale, MAAS) and decentering (Experiences Questionnaire, EQ), and qualitative reports on participation motivations, preferred practices, learnings, and stress management. Correlations included quantitative changes over time (T1-T0, T2-T0, and T2-T1). The results show that the ASI factor Heightened Cognition increased post-course (T1-T0), while ASI Heightened Emotionality (T2-T0) and total aberrant salience (T2-T1) decreased. MAAS and EQ scores increased (T1-T0, T2-T0). MAAS scores (T1-T0, T2-T0) correlated negatively with ASI Heightened Emotionality (T2-T0). Qualitative analyses indicated consistent stressors but improved stress management, applying the course contents and integrating mindfulness into everyday life, even three months afterward. In conclusion, along with improved well-being and stress management, mindfulness might modify pre-attentional and attentional processes such as reduced aberrant salience, besides enhanced mindful attention and decentering. Importantly, mindful attention might predict and promote aberrant salience reductions, warranting future research on treatment approaches and mechanisms of mindfulness in psychosis.\u003c/p\u003e","manuscriptTitle":"Mindfulness predicts reduced aberrant salience and improves stress management","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 01:51:36","doi":"10.21203/rs.3.rs-4528848/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3e2e4576-0157-4f92-89b3-11956f39c3d4","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-24T10:08:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-10 01:51:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4528848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4528848","identity":"rs-4528848","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}