Journal of Trauma & Dissociation

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wjtd20

Mindfulness Meditation Leads To Increased

Dispositional Mindfulness And Interoceptive
Awareness Linked To A Reduced Dissociative
Tendency

Fabio D’Antoni, Susanna Feruglio, Alessio Matiz, Damiano Cantone &

Cristiano Crescentini

To cite this article: Fabio D’Antoni, Susanna Feruglio, Alessio Matiz, Damiano Cantone &
Cristiano Crescentini (2021): Mindfulness Meditation Leads To Increased Dispositional Mindfulness
And Interoceptive Awareness Linked To A Reduced Dissociative Tendency, Journal of Trauma &
Dissociation, DOI: 10.1080/15299732.2021.1934935

To link to this article: https://doi.org/10.1080/15299732.2021.1934935

Published online: 02 Jun 2021.

Submit your article to this journal

Article views: 103

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

https://www.tandfonline.com/action/journalInformation?journalCode=wjtd20
JOURNAL OF TRAUMA & DISSOCIATION
https://doi.org/10.1080/15299732.2021.1934935

Mindfulness Meditation Leads To Increased Dispositional

Mindfulness And Interoceptive Awareness Linked To A
Reduced Dissociative Tendency
Fabio D’Antoni a,b, Susanna Feruglio a,b
, Alessio Matiz b
, Damiano Cantone a,
b
, and Cristiano Crescentini b
a
Department of Psychology, Sapienza University of Rome, Rome, Italy; bDepartment of Languages and
Literatures, Communication, Education and Society, University of Udine, Udine, Italy

ABSTRACT ARTICLE HISTORY

Dissociation is an involuntary defensive mechanism to protect Received 3 August 2020
oneself by avoiding unbearable internal conflicts or overwhelm­ Accepted 25 January 2021
ing emotions. Cultivating mindful awareness could allow the KEYWORDS
development of voluntary processes that can offer part of the Dissociation; mindfulness
self-protective function of dissociation while favoring internal meditation; interoception;
integration processes. The aim of the present study was to bodily awareness;
explore the effects of a 7-week Mindfulness Oriented Meditation mindfulness-based
(MOM) training on healthy individuals’ self-reported dissociative interventions
experience, mindfulness skills and interoceptive awareness. After
the training, in comparison to a waiting-list control group
(N = 102), the MOM group (N = 110) showed reduced dissociative
tendencies (p < .05), increased dispositional mindfulness
(p < .001) and increased interoceptive awareness (in the aspects
of not-worrying, self-regulation and body listening; p < .001).
Moreover, correlational evidence showed that the more MOM
participants increased in mindfulness skills after the training the
more they reported increased interoceptive awareness and
decreased dissociative functioning (p < .05). Mindfulness skills
also improved with more home meditation practice executed
by MOM participants (p < .05). These findings were attributed to
a possible role of mindfulness meditation in enabling the devel­
opment of volitional processes that afford psychological safety
and integration, in contrast with the involuntary nature of
dissociation.

Introduction
Recently, to build a bridge between the constructs of mindfulness and dis­
sociation, some theoretical models have been proposed (Forner, 2019; Waelde,
2004; Zerubavel & Messman-Moore, 2015); however, only a few empirical
studies have been carried out to address this issue. Moreover, most studies
conducted were correlational, they relied exclusively on self-report measures
(Baer et al., 2004; Walach et al., 2006), or were focused on the consequences of
mindfulness-based therapeutic programs for clinical population with

CONTACT Fabio D’Antoni [email protected] Department of Languages and Literatures,

Communication, Education and Society, University of Udine, Via Margreth 3, Udine 33100, Italy
© 2021 Taylor & Francis
2 F. D’ANTONI ET AL.

dissociative symptoms and/or comorbidity (Baslet & Hill, 2011; Foote & Van
Orden, 2016; Granato et al., 2015). Starting from the conceptualization of
dissociation as a continuum from normal to pathological, the purpose of the
present study is to widen the knowledge of the effects of Mindfulness
Meditation (MM) practice on healthy individuals’ dissociative tendencies.
It has been a long time since Pierre Janet formulated the first concept of
“dissociation” in 1889; nevertheless, its precise definition is still debated: it
differs depending on the adopted perspective (Van Der Hart & Dorahy, 2009).
Basically, all definitions of dissociation agree that it implies a deficit in
integrating or associating information in the manner normally expected, like
a «splitting off of clusters of mental contents from conscious awareness»
(American Psychological Association – APA, 2013, p. 820). Many authors
highlight that this process works as an unconscious defensive mechanism to
reduce psychic conflict, extreme psychological pain, and probably also physi­
cal pain in acute traumatic experiences (Ludwig, 1983; Putnam, 1997).
Traumatic experiences can be split from consciousness through dissociation
by automating the basic functioning of the person (e.g., memory, identity, or
perception), and, in some overwhelming circumstances, this alteration of
consciousness could result adaptive in promoting coping and survival
(Friedman, 2013). However, dissociative experiences can also induce further
stress because the disruption of normal neurocognitive functioning can be
perceived by individuals as a loss of control (Lyssenko et al., 2017). Besides
dissociative disorders, dissociation seems to play a role in many psychiatric
disorders (e.g., Borderline Personality Disorder, BPD, Vermetten & Spiegel,
2014; PTSD; Lanius et al., 2012; and Depression; Parlar et al., 2016). On the
other hand, dissociative experiences do not only belong to different psycho­
pathological disorders but may also be aspects of everyday life. Indeed, in the
literature, the term “normative dissociation” has been proposed to describe
nonpathological experiences such as absorption in daily activities, daydream­
ing, fantasy, and night dreaming (Butler, 2006). Dissociation can thus be
theorized as a continuum from common states of intense absorption, like
spacing out while driving, to serious psychopathology-like Dissociative
Identity Disorder. In these terms, dissociative functioning differs only in the
degree of pervasiveness in daily life (e.g., Bernstein & Putnam, 1986; Holmes
et al., 2005; Putnam, 1997).
Given that dissociation is related to the inability to remain in the present,
leading people to unintentionally let their minds wander, suppress unwanted
experiences, and run on automatic pilot, cultivating mindful awareness may
offer a well-suited intervention to counteract its maladaptive consequences.
The term mindfulness can be used to refer to a psychological feature,
a practice for improving mindful awareness (e.g., MM), a state of awareness,
or a psychological process (Davidson, 2010). A common definition of mind­
fulness is «paying attention in a particular way, on purpose, in the present
 JOURNAL OF TRAUMA & DISSOCIATION 3

moment, and non-judgmentally» (Kabat-Zinn, 1994, p. 4). Through MM,

practitioners learn to decenter from the procedural learning (automatic beha­
viors, beliefs and feelings) and “reperceive” their mental and somatosensory
experience with equanimity (Shapiro et al., 2006). In addition, MM is designed
to encourage mind-body integration by developing interoceptive awareness
(IA; measured for example, through the Multidimensional Assessment of
Interoceptive Awareness scale, MAIA, Farb et al., 2015; Mehling et al.,
2012). IA can be defined as a multidimensional construct including (a) the
awareness of inner body sensations, (b) behavioral and cognitive regulatory
features (e.g., attentional regulation for body sensations), (c) willingness to
listen and trust sensations for behavioral decisions (Mehling, 2016).
In the last three decades, the practice of MM has received attention not
only in psychological and medical research (Chiesa & Malinowski, 2011),
but also in psychotherapy (see, e.g., Segal et al., 2002). Training in mind­
fulness may bring a wide range of psychosocial outcomes spanning from
better personal well-being and mental health, to enhanced behavior regula­
tion (Brown & Ryan, 2003; Keng et al., 2011). Mindfulness-based interven­
tions showed to be efficacious in several therapeutic contexts and also in
reducing trauma-related symptoms (Taylor et al., 2020); however, there is
still a paucity of literature on mindfulness and dissociation (Forner, 2019;
Neziroglu & Donnelly, 2013; Wagner et al., 2007). More specifically, as
highlighted by Zerubavel and Messman-Moore (2015), few studies focused
on the impact of mindfulness-based therapeutic programs on clinical sam­
ples with dissociative symptoms (see, e.g., acceptance-based interventions
for conversion and dissociative disorders, Baslet & Hill, 2011; and dialec­
tical behavior therapy for BPD and Dissociative Identity Disorder; Foote &
Van Orden, 2016; Granato et al., 2015). There is even less empirical
investigation on the possible outcomes of MM on the dissociative tenden­
cies of healthy individuals: i.e., two studies showed a negative correlation
between dissociation and dispositional mindfulness (Baer et al., 2004;
Walach et al., 2006), but the relationship between these constructs was
not further explored.
In summary, if dissociation is an experience of disconnection from what is
occurring here and now, such as feelings and bodily sensations, then, MM
could help individuals to tolerate and reduce avoidance of psychological pain
through developing an open and accepting awareness of the here-and-now
and volitionally IA.
Our research aims at exploring possible outcomes of a 7-week Mindfulness-
Oriented Meditation (MOM) training on healthy individuals’ self-reported
dissociative experience, mindfulness skills and IA. The assumption is that
individuals attending a MOM training, in comparison with their passive
waitlist control group, would show a reduction in dissociative tendencies,
and a general increase in dispositional mindfulness and IA.
4 F. D’ANTONI ET AL.

Materials and methods

Participants

A group of 219 healthy (no ongoing mental/physical illness reported)

Caucasian graduate and undergraduate Italian students attending Primary
Teacher Education, Professional Education and Sport Sciences at the
University of Udine (Italy) participated in the study in exchange for course
credits. Two MOM courses were organized as university laboratories with
non-compulsory attendance and conducted both in 2019. Depending on the
expected availability of the students during the days and times of the MOM
courses, we assigned 113 participants (99 females and 14 males; mean age:
23.46 ± 3.3 years) to the two MOM courses and 106 participants (97 females
and 9 males; mean age: 22.33 ± 3.19 years) to the waitlist control group, whose
participants were asked to not meditate for the duration of the course.
Informed consent for research assessment was obtained from all participants.
The procedures were approved by the local Ethics of the University of Udine
and were in accordance with the Helsinki Declaration guidelines.

Self-report questionnaires

We administered three self-report questionnaires to all participants over two

testing sessions. The MOM group completed the questionnaires before the
beginning (session 1) and after the end (session 2) of the 7-week MOM
training, while the control group completed the self-report measures in two
temporally matched sessions.

Dissociative experiences scale 2 (DES-II)

In DES-II (Bernstein & Putnam, 1986; Carlson & Putnam, 1993; Schimmenti,
2016; Zingrone & Alvarado, 2001) participants are asked to respond by look­
ing for a numerical percentage for each question on dissociative experiences in
an 11-point Likert scale ranging from 0% to 100%. Several studies showed high
validity and reliability of DES-II scale both in clinical and nonclinical popula­
tions (Frischholz et al., 1990; Schimmenti, 2016; Zingrone & Alvarado, 2001).
We used the overall score of the DES-II for the interpretation of our results,
although we also considered the original three factors included in the scale
(i.e., amnestic dissociation, absorption and imaginative involvement, and
experiences of depersonalization and derealization). Present sample total DES-
II scores Cronbach’s α for control group was .91 (session 1) and .92 (session 2);
for the MOM group was .90 (session 1) and .91 (session 2).

Five facet mindfulness questionnaire (FFMQ)

The Italian version of the 39-item FFMQ (Baer et al., 2006; Giovannini et al.,
2014) measures dispositional mindfulness through five subscales: observing
 JOURNAL OF TRAUMA & DISSOCIATION 5

(obs), describing (des), acting with awareness (act), non-judge (nonjud) and
non-react (nonrea) to inner experiences. Respondents are asked to answer on
a 5-point Likert scale (1 = never or very rarely true, 5 = very often or always
true) to each item. Present sample total FFMQ score Cronbach’s α for control
group was .84 (session 1) and .84 (session 2); for the MOM group was .87
(session 1) and .86 (session 2).

Multidimensional assessment of interoceptive awareness (MAIA)

The MAIA (Calì et al., 2015; Mehling et al., 2012) is a 32-item self-report
questionnaire to measure multiple dimensions of interoception through eight
subscales: Noticing (awareness of uncomfortable, comfortable, and neutral
body sensations), Not-Distracting (tendency not to ignore or distract oneself
from sensations of pain or discomfort), Not-Worrying (tendency not to worry
or experience emotional distress with sensations of pain or discomfort),
Attention Regulation (ability to sustain and control attention to body sensa­
tions), Emotional Awareness (awareness of the connection between body
sensations and emotional states), Self-Regulation (ability to regulate distress
by attention to body sensations), Body Listening (active listening to the body
for insight), and Trusting (experience of one’s body as safe and trustworthy).
Thus, the MAIA questionnaire was originally designed to be a multi-
dimensional assessment of interoceptive awareness. Nonetheless, in the pre­
sent study, we also used the MAIA total score for each participant as a general
index of interoceptive functioning; this was done to explore whether global
changes in interoception could be related to global changes in mindfulness
skills and dissociative functioning. Present sample total MAIA score
Cronbach’s α for control group was .83 (session 1) and .86 (session 2); for
the MOM group was .88 (session 1) and .90 (session 2).

Mindfulness-oriented meditation (MOM)

Participants in the experimental group attended a slightly reduced version of

the 8-week MOM program (Crescentini et al., 2016, 2014; Fabbro & Muratori,
2012). The MOM training for this study was organized into seven weekly
sessions of 90 minutes. Each session included a short teaching on topics
concerning mindfulness, an MM practice of 30 minutes, and a final discussion
about participants’ experience. The practice was the same throughout the
course and was divided into three parts of 10 minutes each: mindfulness of
breathing, body scan, and observation of the states of the mind such as
thoughts, emotions, and sensations. Participants were given an audio file
featuring the voice of a senior MOM instructor who guided 30 minutes of
meditation through the same three steps described above, and they were asked
to meditate daily at home and to note times and duration of each practice in
a meditation diary. The diaries revealed that participants carried out on
6 F. D’ANTONI ET AL.

average 1.73 (SD = 1.32) meditations per week at home, in addition to the
weekly group meditations attended during MOM meetings.

Statistical analysis
First of all, we tested the distribution of each questionnaire scores (DES-II,
FFMQ, MAIA) among the MOM and control participants for normality with
the Shapiro–Wilk’s W test. Since DES-II scores were non-normally distributed
(p < .01), for this questionnaire we used the Mann–Whitney test and the
Wilcoxon Signed Ranks test to examine whether there were between-subject
and within-subject differences in dissociative functioning. For the analysis of
FFMQ and MAIA data, we performed mixed-model ANOVAs with Session
(Session 1 and Session 2) and Facet (observing, describing, acting with aware­
ness, non-judging, and non-reactivity for the FFMQ questionnaire and
Noticing, Not-distracting, Not-worrying, Attention Regulation, Emotional
Awareness, Self-regulation, Body Listening, and Trusting for MAIA) as
within-subject factors and Group (MOM and Controls) as between-subject
factor. As the number of items in each FFMQ and MAIA subscales are
different, raw scores were normalized to the number of items for each subscale.
To check for possible outliers, we first calculated for each participant three
indexes reflecting the extent of overall change in mindfulness skills, dissocia­
tive functioning, and interoceptive functioning (i.e., Session 2 DES-II/FFMQ/
MAIA total mean scores minus Session 1 DES-II/FFMQ/MAIA total mean
scores). We then excluded from all the analyses the data of participants whose
scores in any of the three indexes were more than 3 SD below or above the
group mean (MOM and controls): we excluded three MOM participants and
four control participants. The overall analyses were thus based on 110 MOM
participants and 102 control participants.
A sensitivity power analysis was conducted for the ANOVAs using the
program G*Power 3.1 (Faul et al., 2009, 2007). This analysis determined that
the present study was sensitive enough (i.e., when the Minimum Detectable
Effect, MDE, is smaller than the observed effect) to detect the differences of
interest, based on available sample size (N = 212), a power of 0.80, and an α
level of 0.05 (see Results for details).
In all ANOVAs, post hoc tests were corrected for multiple comparisons
according to the Bonferroni procedure. Moreover, we ran non-parametric
correlations to assess, for each group, the relationship between the three
above-mentioned indexes of dissociative, mindfulness, and interoceptive func­
tioning and the number of home meditations (self-reported by MOM partici­
pants). We used a significance threshold of p < .05 in all statistical tests, and we
reported effect sizes for parametric analyses as partial eta squared (ηp2). The
data were analyzed with Statistica 8 (StatSoft, Inc, Tulsa, OK). The data that
 JOURNAL OF TRAUMA & DISSOCIATION 7

support the findings of this study are available from the corresponding author,
upon request.

Results
Dissociative functioning
Table 1 reports the individuals’ data for each questionnaire and testing session.
We first tested whether there were differences between MOM and controls
before the MOM training (Session 1). Participants did not differ in total DES-
II scores or in any of the three subscales (absorption, amnesia, and deperso­
nalization–derealization; all Mann–Whitney U > 5082, p > .22). According to
the norming group for DES-II, the mean score for dissociative experiences of
the participants was in line with the normative data (Schimmenti, 2016).
Nonetheless, in the first assessment, we found that 24 (11.3%) subjects (11 in
the MOM group and 13 controls) reported highly dissociative tendencies (i.e.
a total DES-II raw score > .30); instead, after the MOM training, there were
a total of 20 (9.4%) participants with high dissociative tendencies (7 in the
MOM group and 13 controls). After the MOM training, the two groups
differed in total DES-II mean scores and in the scores obtained in the dis­
sociative amnesia subscale (both Mann–Whitney U < 4720, p < .05): MOM
participants reported lower scores than controls (Table 1). No difference was
found in the absorption and depersonalization–derealization scales (both
Mann–Whitney U > 4898, p > .10).
Within-group differences showed Session 2 vs. Session 1 changes in scores
(Session 2 < Session 1) for MOM participants in the total DES-II score as well
as in the amnesia and absorption subscales (all Wilcoxon T < 1659, p < .001).
No Session 2 vs. Session 1 changes in dissociative functioning were found for
control participants (all Wilcoxon T > 1247, p > .13). Overall, the MOM
training led to reduced scores in the DES-II scale and in particular in the
dissociative amnesia subscale among the MOM participants (Table 1).

Mindfulness skills
On the basis of a 2 (Session: Session 1 and Session 2) × 2 (Group: MOM and
controls) × 5 (Facet: obs, des, act, non-jud, non-rea) mixed-model ANOVA
carried out on the FFMQ scores, there were significant main effects of Facet (F
[4, 840] = 49.61, p < .001; ηp2 = .191, MDE ηp2 = .006) and Session (F [1,
210] = 4.96, p < .03; ηp2 = .023, MDE ηp2 = .009) as well as their interaction (F
[4, 840] = 10.01, p < .001; ηp2 = .045, MDE ηp2 = .006). Moreover, there was an
interaction between Session and Group (F [1, 210] = 9.94, p < .002; ηp2 = .045,
MDE ηp2 = .009). Post hoc tests performed for the Session x Facet interaction
indicated global higher scores at Session 2 vs. Session 1 specifically for non-jud
8 F. D’ANTONI ET AL.

Table 1. Self-report questionnaire scores (Ms, SDs, range (min/max)) in testing sessions 1 and 2 for
MOM and control participants.
MOM Group (n = 110) Control Group (n = 102)
Session 1 Session 2 Session 1 Session 2
DES-II Dissociative Amnesia .08 .06 .09 .09
.07 .07 .09 .09
.00/.33 .00/.34 .00/.42 .00/.42
DES-II Absorption and Imaginative Involvement .26 .22 .28 .26
.14 .13 .16 .16
.04/.71 .00/.54 .04/.73 .03/.69
DES-II Depersonalization and Derealization .09 .08 .09 .10
.10 .08 .11 .10
.00/.53 .00/.46 .00/.51 .00/.51
DES-II .16 .14 .17 .17
Total Score .10 .09 .11 .11
.02/.49 .00/.40 .02/.51 .02/.46
FFMQ 3.13 3.12 3.16 3.11
Observe .63 .63 .66 .64
1.88/4.63 1.38/4.50 1.25/4.75 1.25/4.63
FFMQ 3.25 3.30 3.23 3.14
Describe .68 .77 .73 .80
1.88/4.88 1.63/5.00 1.63/4.88 1.13/5.00
FFMQ 3.26 3.41 3.41 3.41
Act with Awareness .76 .72 .72 .70
1.38/4.75 1.00/5.00 1.38/5.00 1.50/5.00
FFMQ 3.03 3.38 3.15 3.28
Non-judge .92 .92 .80 .86
1.00/4.75 1.13/5.00 1.38/4.88 1.13/5.00
FFMQ 2.59 2.63 2.65 2.56
Non-react .63 .59 .51 .47
1.00/4.71 1.43/4.14 1.14/4.43 1.29/3.71
FFMQ 3.07 3.18 3.13 3.12
Total Score .43 .40 .40 .38
1.97/4.13 2.23/4.10 2.05/4.00 2.13/4.05
MAIA 3.19 3.08 3.38 3.40
Noticing .79 .83 .81 .70
1.25/5.00 .50/5.00 1.00/5.00 1.75/5.00
MAIA 2.31 2.42 2.07 2.13
Not-Distracting .64 .64 .65 .53
.67/4.00 1.00/4.33 0.00/3.67 1.00/3.67
MAIA 2.25 2.59 2.23 2.16
Not-Worrying .97 .98 .81 .78
.00/4.33 .33/5.00 .33/4.00 .33/4.00
MAIA 2.48 2.58 2.84 2.76
Attention Regulation .80 .80 .65 .66
.71/4.57 .57/4.71 1.00/4.57 1.14/4.57
MAIA 3.42 3.26 3.49 3.37
Emotional Awareness .81 .90 .81 .83
1.60/5.00 1.00/5.00 1.00/5.00 1.40/5.00
MAIA 2.22 2.62 2.61 2.50
Self-Regulation .91 .90 .77 .77
.25/4.50 .25/4.50 1.00/4.50 1.00/4.25
MAIA 2.27 2.58 2.58 2.46
Body Listening .86 .93 .87 .82
.33/5.00 .67/4.67 1.00/4.67 1.00/4.67
MAIA 3.00 3.14 3.29 3.18
Trusting 1.03 1.02 .96 .96
1.00/5.00 .33/5.00 1.00/5.00 1.00/5.00
MAIA 2.68 2.79 2.88 2.80
Total Score .51 .54 .42 .43
1.28/4.19 1.16/4.09 2.00/3.94 1.81/3.78
DES-II = Dissociative Experiences Scale-II; FFMQ = Five Facet Mindfulness Questionnaire; MAIA = Multidimensional
Assessment of Interoceptive Awareness; MOM = Mindfulness-Oriented Meditation.
 JOURNAL OF TRAUMA & DISSOCIATION 9

(p < .001). Post-hoc tests executed for the Session x Group interaction showed
globally higher mindfulness skills at Session 2 vs. Session 1 only for MOM
participants (p < .001) (Table 1). No other main effects or interactions were
significant. Thus, MOM training led to higher scores on the FFMQ at Session 2
than Session 1, only among MOM participants, indicating higher dispositional
mindfulness for these participants.

Interoceptive functioning

On the basis of a 2 (Session: Session 1 and Session 2) × 2 (Group: MOM and

controls) × 8 (Facet: Noticing, Not-distracting, Not-worrying, Attention
Regulation, Emotional Awareness, Self-regulation, Body Listening, and
Trusting) mixed-model ANOVA carried out on the MAIA scores, there
were the significant main effect of Facet (F [7, 1470] = 104.66, p < .001; ηp2
= .332, MDE ηp2 = .004), the two factor interactions between Session x Group
(F [1, 210] = 16.64, p < .001; ηp2 = .073, MDE ηp2 = .009), Facet x Group (F [7,
1470] = 5.17, p < .001; ηp2 = .024, MDE ηp2 = .004), and Session x Facet (F [7,
1470] = 3.91, p < .001; ηp2 = .018, MDE ηp2 = .004), and the three-way
interaction between Session, Facet and Group (F [7, 1470] = 5.61, p < .001;
ηp2 = .026, MDE ηp2 = .004). In view of this three-way interaction, we ran two
mixed model 2 × 8 ANOVAs, one for each participant group, including
Session and Facet. The ANOVA executed for the MOM group returned the
significant interaction between Session and Facet (F [7, 763] = 7.69, p < .001;
ηp2 = .065, MDE ηp2 = .008). Post hoc tests showed increased scores at Session
2 vs. Session 1 for Not-worrying, Self-regulation and Body Listening (all p <
.001) (Table 1). By contrast, the ANOVA executed for the control group did
not return a significant interaction between Session and Facet (F [7, 707] =
1.13, p = .33; ηp2 = .011) (Table 1). Thus, MOM training led to higher scores on
specific MAIA facets (i.e., Not-worrying, Self-regulation and Body Listening),
indicating enhanced interoceptive and self-regulation functioning for MOM
participants.

Correlations
With regards to correlations between the three indexes of dissociative, mind­
fulness, and interoceptive functioning (and the number of home meditations
performed by MOM participants), we obtained significant effects, specifically
for the MOM group, for the correlations between the index of Session 2 minus
Session 1 global change in mindfulness skills (FFMQ total scores) and the
relative indexes of dissociative functioning (DES-II total scores) (Rho = −.219,
p < .05), interoceptive functioning (MAIA total scores) (Rho = .458, p < .05),
and amount of home meditation (Rho = .366, p < .05): the more MOM
participants increased in their global mindfulness skills after the training the
10 F. D’ANTONI ET AL.

more they showed increased interoceptive global scores and decreased dis­
sociative functioning. Mindfulness skills also increased with more home
meditation executed by MOM participants. No significant correlations were
found in the control group.

Discussion
The purpose of this research was to explore in a sample of young healthy
participants the effect of a mindfulness-oriented meditation (MOM) training
on the individual’s tendency to dissociative functioning, interoceptive aware­
ness (IA) and mindfulness skills. We compared a MOM group with a passive
waitlist control group using pre-post self-report measures (DES-II, MAIA,
FFMQ). The data showed a specific effect of MOM in enhancing mindfulness
skills and specific IA components such as not-worrying, self-regulation and
body listening, and in reducing dissociative functioning such as the tendency
to dissociative amnesia and imaginative involvement. Moreover, we found
that MOM participants’ global changes in mindfulness skills, IA and dissocia­
tion tended to be correlated, although caution should be used when interpret­
ing these correlations because they cannot determine the direction of
causation (for example, between mindfulness skills and dissociative function­
ing) and also because we used global indexes of mindfulness, dissociative, and
interoceptive functioning that may not fully reflect the complex multidimen­
sional nature of these constructs.
As expected, our findings support previous evidence showing that disposi­
tional mindfulness and IA can be cultivated through MM training (Quaglia
et al., 2016). Moreover, we confirmed and extended findings of previous
research papers showing a negative correlation between dispositional mind­
fulness and dissociative functioning of healthy individuals measured via self-
report questionnaires (Baer et al., 2004; Walach et al., 2006). The practice of
MM, in addition to increasing participants’ awareness toward present moment
experience, led to a reduction in dissociative tendencies, especially dissociative
amnesia (e.g., not knowing how you got somewhere) and absorption and
imaginative involvement (e.g., realizing that you did not hear part or all of
what was said by another).
Memory leaking as a form of amnesic barrier may belong to the dissociative
tendency to compartmentalize information and affectivity (Zerubavel &
Messman-Moore, 2015). It concerns the splitting between consciousness and
memory, and, from a defensive point of view, it allows experiential avoidance
and offers the individual a mechanism to store and retrieve emotionally
charged information separately from other pieces of information should the
association of the two cause painful cognitive dissonance. Conversely, MM
encourages bringing attention to the experience of “here and now” and trying
to reduce as much as possible the distracting effect produced by the recurrent
 JOURNAL OF TRAUMA & DISSOCIATION 11

coming up of thoughts and memories. Previous research has already shown

the positive link between mindfulness and memory (Bonamo et al., 2015; Jha
et al., 2010). A clinical implication of the present data may be that mind­
fulness-based treatments could reduce the involuntary experiential avoidance,
such as amnestic barriers, and then favor the contact with distressful memories
because of a more open and curious attitude (Forner, 2019).
Turning to absorption, people fully involved in a mental scenario to the
point of not noticing what is happening around them, may find themselves
unsure of what they have done or said because their awareness was absorbed
only by a small part of experience. Although the tendency to function in
a dissociative way is normal in certain situations, high levels of absorption
are linked to mental suffering (Soffer-Dudek et al., 2015) and PTSD (Armour
et al., 2014). Moreover, this state of being engrossed in something seems to be
close to the concept of mind-wandering as an immersive focusing of attention
on internal train of thoughts (Mrazek, Smallwood, & Schooler, 2012;
Smallwood, 2013). Thus, as MM can promote the capacity to stay with one’s
mental activity (Ainsworth et al., 2017) and to manage disturbing thoughts
with decreased emotional reactivity (Brown & Ryan, 2003), then it is also
conceivable that it may help individuals to reduce dissociative absorption and
imaginative involvement.
As regards the effects of MOM on IA, in agreement with previous studies,
our results indicate that IA may be a key component of MM interventions
(Farb et al., 2015; Mehling et al., 2012). Indeed, MOM training improved
participants’ ability to pay attention to somatic cues and to cope with disturb­
ing feelings; it also heightened their ability to “listen” to bodily sensations as
sources of information, and it reduced the extent to which participants
worried about their feelings of discomfort. Protracted MM may promote
a switching from reasoning about body sensations to feeling them in the
present moment; this, in turn, may help reduce dissociative tendencies to
remain stuck in an absorbed and detached state of mind. These findings
could support the potential efficacy of bottom-up psychotherapeutic techni­
ques like “sensorimotor sequencing” for trauma (Ogden & Minton, 2000) and
corroborate evidence showing a positive relation between IA and emotional
and behavioral regulation (Herbert et al., 2007; Wiens, 2005).
Notably, we found that MOM participants’ changes in mindfulness skills,
home meditation, IA and dissociation tended to be correlated: the more they
increased their mindfulness skills after the MOM training the more they
showed increased IA and decreased dissociative functioning. We thus pro­
vided a preliminary empirical contribution to the study of mindfulness and
dissociation: training in MM could promote cultivation of mindfulness and
interoceptive skills in daily life that consequently may lead to a better psycho­
logical integration, with a positive impact in terms of less distress and need of
dissociative defensive processes. These findings need to be extended in further
12 F. D’ANTONI ET AL.

studies in other non-clinical samples and people with psychiatric disorders

within a wider theoretical and practical framework on the clinical implications
for treatment of dissociative patients. For example, some caution must be
taken when introducing MM to dissociative patients: they might dissociate
during meditation or confuse MM with dissociation (Zerubavel & Messman-
Moore, 2015). Clinicians could refer to frameworks like the “window of
tolerance” or the “modulation model” when proposing mindful exercises to
patients with dissociative problems (Ogden et al., 2006; Siegel, 1999).
Concerning present study limitations, the subjects in our sample were
university students, with a high prevalence of female participants; therefore,
it is difficult to extend these findings to other populations. Moreover, a small
part of participants was attending Sport Sciences and their regular sport
practice might have had some influence on their level of interoceptive aware­
ness. Other issues concern the sole use of self-report questionnaires, which can
be affected by desirable and subjective responding, and the lack of a follow-up
session.
In conclusion, our research produced relevant results showing the beneficial
effects of MM on non-clinical individuals’ dissociative tendencies, mindful­
ness and IA skills. We found that MM led to enhanced dispositional mind­
fulness and interoceptive awareness together with a reduced dissociative
functioning. These results were attributed to the potential contribution of
MM in enabling the increasing development of mindful responses to the
challenges of life, in contrast with the reactive and defensive features of
dissociation.

Declaration of interest statement

The authors declare that they have no conflict of interest.

ORCID
Fabio D’Antoni http://orcid.org/0000-0002-4509-6910
Susanna Feruglio http://orcid.org/0000-0002-3915-5195
Alessio Matiz http://orcid.org/0000-0001-6785-3102
Damiano Cantone http://orcid.org/0000-0003-3604-5537
Cristiano Crescentini http://orcid.org/0000-0002-3154-3687

References
Ainsworth, B., Bolderston, H., & Garner, M. (2017). Testing the differential effects of accep­
tance and attention-based psychological interventions on intrusive thoughts and worry.
Behaviour Research and Therapy, 91, 72–77. https://doi.org/10.1016/j.brat.2017.01.012
American Psychological Association - APA. (2013). Diagnostic and statistical manual of mental
disorders (DSM-5®) (Fifth ed.). American Psychiatric Publishing.
 JOURNAL OF TRAUMA & DISSOCIATION 13

Armour, C., Contractor, A. A., Palmieri, P. A., & Elhai, J. D. (2014). Assessing latent level
associations between PTSD and dissociative factors: Is depersonalization and derealization
related to PTSD factors more so than alternative dissociative factors? Psychological Injury
and Law, 7(2), 131–142. https://doi.org/10.1007/s12207-014-9196-9
Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report.
Assessment, 11(3), 191–206. https://doi.org/10.1177/1073191104268029
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report
assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.
org/10.1177/1073191105283504
Baslet, G., & Hill, J. (2011). Case report: Brief mindfulness-based psychotherapeutic interven­
tion during inpatient hospitalization in a patient with conversion and dissociation. Clinical
Case Studies, 10(2), 95–109. https://doi.org/10.1177/1534650110396359
Bernstein, E. M., & Putnam, F. V. (1986). Development, reliability, and validity of
a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.
org/10.1097/00005053-198612000-00004
Bonamo, K. K., Legerski, J.-P., & Thomas, K. B. (2015). The influence of a brief mindfulness
exercise on encoding of novel words in female college students. Mindfulness, 6(3), 535–544.
https://doi.org/10.1007/s12671-014-0285-3
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in
psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.
https://doi.org/10.1037/0022-3514.84.4.822
Butler, L. D. (2006). Normative dissociation. Psychiatric Clinics of North America, 29(1), 45–62.
https://doi.org/10.1016/j.psc.2005.10.004
Calì, G., Ambrosini, E., Picconi, L., Mehling, W. E., & Committeri, G. (2015). Investigating the
relationship between interoceptive accuracy, interoceptive awareness, and emotional
susceptibility. Frontiers in Psychology, 6, 1202. https://doi.org/10.3389/fpsyg.2015.01202
Carlson, E. B., & Putnam, F. W. (1993). An update on the dissociative experiences scale.
Dissociation: Progress in the Dissociative Disorders, 6(1), 16–27. https://psycnet.apa.org/
record/1994-27927-001
Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same?
Journal of Clinical Psychology, 67(4), 404–424. https://doi.org/10.1002/jclp.20776
Crescentini, C., Chittaro, L., Capurso, V., Sioni, R., & Fabbro, F. (2016). Psychological and
physiological responses to stressful situations in immersive virtual reality: Differences
between users who practice mindfulness meditation and controls. Computers in Human
Behavior, 59, 304–316. https://doi.org/10.1016/j.chb.2016.02.031
Crescentini, C., Urgesi, C., Campanella, F., Eleopra, R., & Fabbro, F. (2014). Effects of an
8-week meditation program on the implicit and explicit attitudes toward religious/spiritual
self-representations. Consciousness and Cognition, 30, 266–280. https://doi.org/10.1016/j.
concog.2014.09.013
Davidson, R. J. (2010). Empirical explorations of mindfulness: Conceptual and methodological
conundrums. Emotion, 10(1), 8–11. https://doi.org/10.1037/a0018480
Fabbro, F., & Muratori, F. (2012). La mindfulness: Un nuovo approccio psicoterapeutico in età
evolutiva. Giornale Di Neuropsichiatria Dell’Età Evolutiva, 32, 1–15. https://www.medra.
org/servlet/MREngine?hdl=10.3280/RIP2016–004001
Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., Klein, A. C., Paulus, M. P.,
& Mehling, W. E. (2015). Interoception, contemplative practice, and health. Frontiers in
Psychology, 6, 763. https://doi.org/10.3389/fpsyg.2015.00763
Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using
G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41
(4), 1149–1160. https://doi.org/10.3758/BRM.41.4.1149
14 F. D’ANTONI ET AL.

Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power
analysis program for the social, behavioral, and biomedical sciences. Behavior Research
Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146
Foote, B., & Van Orden, K. (2016). Adapting dialectical behavior therapy for the treatment of
dissociative identity disorder. American Journal of Psychotherapy, 70(4), 343–364. https://
doi.org/10.1176/appi.psychotherapy.2016.70.4.343
Forner, C. (2019). What mindfulness can learn about dissociation and what dissociation can
learn from mindfulness. Journal of Trauma & Dissociation, 20(1), 1–15. https://doi.org/10.
1080/15299732.2018.1502568
Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting here from there and where to go
next. Journal of Traumatic Stress, 26(5), 548–556. https://doi.org/10.1002/jts.21840
Frischholz, E. J., Braun, B. G., Sachs, R. G., Hopkins, L., & Al, E. (1990). The dissociative
experiences scale: Further replication and validation. Dissociation: Progress in the
Dissociative Disorders, 3(3), 151–153. http://hdl.handle.net/1794/1653
Giovannini, C., Giromini, L., Bonalume, L., Tagini, A., Lang, M., & Amadei, G. (2014). The
Italian five facet mindfulness questionnaire: A contribution to its validity and reliability.
Journal of Psychopathology and Behavioral Assessment, 36(3), 415–423. https://doi.org/10.
1007/s10862-013-9403-0
Granato, H. F., Wilks, C. R., Miga, E. M., Korslund, K. E., & Linehan, M. M. (2015). The use of
dialectical behavior therapy and prolonged exposure to treat comorbid dissociation and
self-harm: The case of a client with borderline personality disorder and posttraumatic stress
disorder. Journal of Clinical Psychology, 71(8), 805–815. https://doi.org/10.1002/jclp.22207
Herbert, B. M., Pollatos, O., & Schandry, R. (2007). Interoceptive sensitivity and emotion
processing: An EEG study. International Journal of Psychophysiology, 65(3), 214–227.
https://doi.org/10.1016/j.ijpsycho.2007.04.007
Holmes, E., Brown, R., Mansell, W., Fearon, R., Hunter, E., Frasquilho, F., & Oakley, D. (2005).
Are there two qualitatively distinct forms of dissociation? A review and some clinical
implications. Clinical Psychology Review, 25(1), 1–23. https://doi.org/10.1016/j.cpr.2004.08.
006
Jha, A. P., Stanley, E. A., Kiyonaga, A., Wong, L., & Gelfand, L. (2010). Examining the
protective effects of mindfulness training on working memory capacity and affective
experience. Emotion, 10(1), 54–64. https://doi.org/10.1037/a0018438
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life
(1st ed.). Hyperion.
Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological
health: A review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056. https://
doi.org/10.1016/j.cpr.2011.04.006
Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative
subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence,
and implications. Depression and Anxiety, 29(8), 701–708. https://doi.org/10.1002/da.21889
Ludwig, A. M. (1983). The psychobiological functions of dissociation. American Journal of
Clinical Hypnosis, 26(2), 93–99. https://doi.org/10.1080/00029157.1983.10404149
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2017).
Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative
experiences scale. American Journal of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/
appi.ajp.2017.17010025
Mehling, W. E. (2016). Differentiating attention styles and regulatory aspects of self-reported
interoceptive sensibility. Philosophical Transactions of the Royal Society B: Biological
Sciences, 371(1708), 20160013. https://doi.org/10.1098/rstb.2016.0013
 JOURNAL OF TRAUMA & DISSOCIATION 15

Mehling, W. E., Price, C., Daubenmier, J. J., Acree, M., Bartmess, E., Stewart, A., & Tsakiris, M.
(2012). The multidimensional assessment of interoceptive awareness (MAIA). PLoS ONE, 7
(11), e48230. https://doi.org/10.1371/journal.pone.0048230
Mrazek, M. D., Smallwood, J., & Schooler, J. W. (2012). Mindfulness and mind-wandering:
Finding convergence through opposing constructs. Emotion, 12(3), 442–448. https://doi.
org/10.1037/a0026678
Neziroglu, F., & Donnelly, K. (2013). Dissociation from an acceptance-oriented standpoint. In
F. Kennedy, H. Kennerley, & D. Pearson (Eds.), Cognitive behavioural approaches to the
understanding and treatment of dissociation (pp. 236–250). Routledge.
Ogden, P., & Minton, K. (2000). Sensorimotor psychotherapy: One method for processing
traumatic memory. Traumatology, 6(3), 149–173. https://doi.org/10.1177/
153476560000600302
Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to
psychotherapy. W.W. Norton & Company.
Parlar, M., Frewen, P. A., Oremus, C., Lanius, R. A., & McKinnon, M. C. (2016). Dissociative
symptoms are associated with reduced neuropsychological performance in patients with
recurrent depression and a history of trauma exposure. European Journal of
Psychotraumatology, 7(1), 29061. https://doi.org/10.3402/ejpt.v7.29061
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective.
Guilford Press.
Quaglia, J. T., Braun, S. E., Freeman, S. P., McDaniel, M. A., & Brown, K. W. (2016). Meta-
analytic evidence for effects of mindfulness training on dimensions of self-reported disposi­
tional mindfulness. Psychological Assessment, 28(7), 803–818. https://doi.org/10.1037/
pas0000268
Schimmenti, A. (2016). Dissociative experiences and dissociative minds: Exploring
a nomological network of dissociative functioning. Journal of Trauma & Dissociation, 17
(3), 338–361. https://doi.org/10.1080/15299732.2015.1108948
Segal, Z. V., Williams, J., & Teasdale, J. (2002). Mindfulness-based cognitive therapy for
depression: A new approach to preventing relapse. Guildford.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness.
Journal of Clinical Psychology, 62(3), 373–386. https://doi.org/10.1002/jclp.20237
Siegel, D. (1999). The developing mind: How relationships and the brain interact to shape who
we are. Guilford Press.
Smallwood, J. (2013). Distinguishing how from why the mind wanders: A process–occurrence
framework for self-generated mental activity. Psychological Bulletin, 139(3), 519–535.
https://doi.org/10.1037/a0030010
Soffer-Dudek, N., Lassri, D., Soffer-Dudek, N., & Shahar, G. (2015). Dissociative absorption:
An empirically unique, clinically relevant, dissociative factor. Consciousness and Cognition,
36, 338–351. https://doi.org/10.1016/j.concog.2015.07.013
Taylor, J., McLean, L., Korner, A., Stratton, E., & Glozier, N. (2020). Mindfulness and yoga for
psychological trauma: Systematic review and meta-analysis. Journal of Trauma &
Dissociation, 21(5), 536–573. https://doi.org/10.1080/15299732.2020.1760167
van der Hart, O., & Dorahy, M. J. (2009). History of the concept of dissociation. In P. F. Dell &
J. A. O'Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (p. 3–
26). Routledge/Taylor & Francis Group. https://psycnet.apa.org/record/2008-03212–001
Vermetten, E., & Spiegel, D. (2014). Trauma and dissociation: Implications for borderline
personality disorder. Current Psychiatry Reports, 16(2), 434. https://doi.org/10.1007/s11920-
013-0434-8
Waelde, L. C. (2004). Dissociation and meditation. Journal of Trauma & Dissociation, 5(2),
147–162. https://doi.org/10.1300/J229v05n02_08
16 F. D’ANTONI ET AL.

Wagner, A. W., Rizvi, S. L., & Harned, M. S. (2007). Applications of Dialectical Behavior
therapy to the treatment of complex trauma-related problems: When one case formulation
does not fit all. Journal of Traumatic Stress, 20(4), 391–400. https://doi.org/10.1002/jts.20268
Walach, H., Buchheld, N., Buttenmüller, V., Kleinknecht, N., & Schmidt, S. (2006). Measuring
mindfulness - The Freiburg Mindfulness Inventory (FMI). Personality and Individual
Differences, 40(8), 1543–1555. https://doi.org/10.1016/j.paid.2005.11.025
Wiens, S. (2005). Interoception in emotional experience. Current Opinion in Neurology, 18(4),
442–447. https://doi.org/10.1097/01.wco.0000168079.92106.99
Zerubavel, N., & Messman-Moore, T. L. (2015). Staying present: Incorporating mindfulness
into therapy for dissociation. Mindfulness, 6(2), 303–314. https://doi.org/10.1007/s12671-
013-0261-3
Zingrone, N. L., & Alvarado, C. S. (2001). The Dissociative Experiences Scale-II: Descriptive
statistics, factor analysis, and frequency of experiences. Imagination, Cognition and
Personality, 21(2), 145–157. https://doi.org/10.2190/K48D-XAW3-B2KC-UBB7