Impulsivity is a key symptom across many mental health conditions, particularly ADHD, where it can manifest as difficulty controlling behaviors, resisting urges, and considering consequences.
Impulsivity can lead to significant functional impairments, risky decision-making, and strained relationships.
Mindfulness, which involves present-moment awareness and non-judgmental acceptance, may help reduce impulsivity by enhancing self-regulation and disrupting automatic response patterns.
By cultivating greater attention to thoughts, emotions, and behavioral urges, mindfulness can create a space between impulse and action, allowing for more conscious choice.
As a transdiagnostic symptom, targeted mindfulness interventions for impulsivity could potentially improve outcomes across a range of conditions.
Aksen, D. E., Sleight, F. G., & Lynn, S. J. (2023). Mindfulness intervention for impulsivity as a stand-alone treatment: A qualitative review of emerging evidence. Psychology of Consciousness: Theory, Research, and Practice. Advance online publication. https://doi.org/10.1037/cns0000367
Key Points
- Mindfulness-based interventions show promise for reducing impulsivity as a stand-alone treatment based on a qualitative review of 15 studies.
- Factors like the type of mindfulness intervention, sample characteristics, comparison treatments, outcome measures, and study design significantly affect the ability to draw firm conclusions about effectiveness.
- The research, while enlightening, has certain limitations, such as small sample sizes, lack of standardization of mindfulness treatments, reliance on self-report measures, and high risk of bias in many studies.
- Addressing impulsivity is universally relevant given its prevalence across disorders and negative impact on individuals and society. Impulsivity contributes to maladaptive behavioral, cognitive, affective and social consequences.
Rationale
Impulsivity is a transdiagnostic trait that contributes to problem behaviors and psychological symptoms across the lifespan and in many domains of life (Beauchaine & Neuhaus, 2008).
It is included in diagnostic criteria for multiple disorders in the DSM-5-TR, including ADHD, substance use disorders, bipolar disorder, and personality disorders (American Psychiatric Association, 2022).
Prevalence rates indicate impulsivity affects a substantial portion of the population, with estimates of 7% in children and 17% in adults (Palili et al., 2011; Chamorro et al., 2012).
Psychotherapies have traditionally addressed impulsivity indirectly as part of treatment for broader psychopathology. Some therapies incorporate mindfulness to target impulsivity (e.g., DBT; Linehan, 1987).
However, the independent efficacy of mindfulness as a stand-alone treatment for impulsivity is unclear. Given that mindfulness and impulsivity seem to reflect opposite ends of a continuum in terms of awareness and response inhibition (Murphy & Mackillop, 2012), mindfulness skills alone may be sufficient to reduce impulsivity.
The current qualitative review aims to address this gap by evaluating studies that have examined the effectiveness of stand-alone mindfulness interventions for impulsivity.
Parsing the unique impact of mindfulness will broaden understanding of its therapeutic value and guide future treatment development.
Method
Qualitative Metasynthesis
The authors conducted electronic literature searches in APA PsycArticles, APA PsycInfo, Google Scholar, and PubMed databases to identify peer-reviewed articles on the effectiveness of mindfulness-only interventions for reducing impulsivity.
Search terms included variations of “mindfulness” and “impulsivity.” Articles were limited to those published in English between 1985-2021.
159 abstracts were screened, and 40 full-text articles were assessed for eligibility based on inclusion criteria of 1) explicit investigation of mindfulness intervention impact on impulsivity outcomes, 2) use of an adequately developed and described mindfulness intervention, and 3) inclusion of valid and reliable impulsivity outcome measures.
Studies were excluded if they examined mindfulness or impulsivity only as a mediator/moderator, combined mindfulness with other well-defined treatment protocols, inappropriately labeled the intervention as mindfulness, or measured impulsivity-adjacent constructs like urges.
15 articles met inclusion criteria for the qualitative review.
The authors also conducted a risk of bias assessment for each included study based on Orwin’s (1994) guidelines.
Studies were evaluated on 10 criteria related to study intent, inclusion criteria, randomization, blinding, intervention standardization, outcome measures, statistical analyses, dropout rates, intent-to-treat analyses, and appropriate conclusions.
Search strategy and terms:
- Databases: APA PsycArticles, APA PsycInfo, Google Scholar, PubMed
- Search terms: mindfulness, mindful, mindfulness-based, impulsivity, impulsive
- Limits: Peer-reviewed, English language, published 1985-2021
- Additional relevant articles identified via reference scanning
Inclusion and exclusion criteria:
- Inclusion criteria:
- Explicit investigation of mindfulness intervention impact on impulsivity
- Adequately developed and described mindfulness intervention
- Valid and reliable impulsivity outcome measures
- Exclusion criteria:
- Mindfulness/impulsivity examined only as mediator/moderator
- Mindfulness combined with other well-defined treatment protocols
- Intervention inappropriately labeled as mindfulness
- Measured only impulsivity-adjacent constructs (e.g., urges)
Statistical measures
Effect sizes (Cohen’s d) were estimated using reported statistics when not provided by authors. The high variability in outcome measures precluded reporting mean scores. Patterns in effect sizes could not be reliably observed across the small number of heterogenous studies.
Results
This qualitative review of 15 studies found mixed evidence for the effectiveness of mindfulness interventions in reducing impulsivity. Ten studies reported significant reductions in impulsivity following mindfulness training, while five found no significant effects.
In non-clinical student and community samples, three out of five studies showed mindfulness to be effective, with the most promising results from multi-week group interventions. Two studies found no significant changes, possibly due to low baseline impulsivity or lack of control group differences.
Among incarcerated populations, two out of three studies supported mindfulness for reducing impulsivity, with benefits seen from both long-term meditation practice and structured MBSR programs. One study found no effects but had significant methodological limitations.
Clinical populations showed the most consistent benefits, with four out of six studies reporting mindfulness-related reductions in impulsivity across various diagnoses (e.g., opiate-use disorder, borderline personality disorder, ADHD). However, two studies with adolescent clinical samples found no significant mindfulness-specific effects.
The heterogeneity of mindfulness protocols, control conditions, and impulsivity measures across studies makes direct comparisons challenging.
More high-quality randomized controlled trials with standardized designs are needed to clarify the specific contexts and populations for which mindfulness is most effective as a standalone treatment for impulsivity.
Insight
This review provides preliminary indications that stand-alone mindfulness treatments may reduce impulsivity, with 10 of 15 studies finding positive effects.
However, the highly variable nature of the studies in terms of populations, mindfulness protocols, control groups, and outcome measures makes it difficult to draw firm conclusions.
There is a clear need for greater standardization and methodological rigor in this research area moving forward.
The fact that some studies found mindfulness no more effective than alternative treatments suggests its unique impact needs to be parsed out more carefully.
Examining potential moderators and mediators will be key to understanding what works best for whom.
Importantly, impulsivity reductions were primarily assessed at immediate post-treatment – whether these effects persist long-term is uncertain based on the lack of follow-up data.
Despite the limitations, this review spotlights mindfulness as a promising approach warranting further investigation as a targeted treatment for impulsivity.
The appeal lies in its potential cost-effectiveness and portability to be implemented across diverse real-world contexts. Ascertaining the independent value of mindfulness, separate from its incorporation in broader treatment protocols, is an important scientific endeavor.
Future research should utilize randomized controlled designs, larger samples, multiple measurement modalities, and longer-term follow-up to establish mindfulness as an empirically-validated stand-alone treatment for impulsivity.
Strengths
This review has several strengths, including:
- Systematic search of multiple databases with clear inclusion/exclusion criteria
- Assessed wide range of sample types (students, inmates, clinical)
- Evaluated studies using risk of bias assessment to weigh strength of evidence
- Estimated effect sizes to facilitate cross-study comparison
- Identified key gaps and made recommendations for future research
Limitations
This review also had several limitations, including:
- Small number of heterogenous studies limits ability to draw firm conclusions
- High risk of bias in many studies due to methodological flaws
- Lack of standardization in mindfulness protocols and impulsivity measures
- Most studies relied on self-report; few used behavioral or physiological measures
- Minimal data on long-term effects due to lack of follow-up assessments
- Potential for publication bias/”file drawer” effect inflating positive findings
The inconsistencies and limitations across studies constrain the strength of the conclusions that can be made about mindfulness as a stand-alone treatment for impulsivity at this stage. Caution is warranted in overgeneralizing these preliminary findings.
Nevertheless, by comprehensively surveying the extant literature, this review provides a valuable springboard for optimizing future research in this area.
Implications
While still an emerging area of study, this review suggests mindfulness could potentially serve as a cost-effective, accessible intervention to reduce the substantial personal and societal toll of impulsivity.
With further empirical validation, stand-alone mindfulness treatments could be an important addition to clinicians’ toolkits.
However, much work remains to translate these preliminary findings into real-world impact. Mindfulness protocols need to be standardized and rigorously tested against well-defined control conditions.
Understanding what specific components of mindfulness are most active in reducing impulsivity will enable treatment optimization. Clarifying the populations and contexts for which mindfulness is maximally beneficial will guide appropriate implementation.
The fact that impulsivity is a cross-cutting construct implicated across diverse clinical conditions underscores the importance of developing targeted, transdiagnostic interventions.
By directing attention and awareness in ways that enable greater self-regulation, mindfulness may disrupt maladaptive impulsive response patterns.
With robust supporting evidence, stand-alone mindfulness could become a first-line treatment recommendation for impulsivity in conditions such as ADHD that promotes meaningful change for individuals and society at large.
The vital next step is leveraging the insights from this review to design high-quality studies that definitively establish mindfulness as an effective, evidence-based intervention for impulsivity.
References
Primary reference
Aksen, D. E., Sleight, F. G., & Lynn, S. J. (2023). Mindfulness intervention for impulsivity as a stand-alone treatment: A qualitative review of emerging evidence. Psychology of Consciousness: Theory, Research, and Practice. Advance online publication. https://doi.org/10.1037/cns0000367
Other references
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Beauchaine, T. P., & Neuhaus, E. (2008). Impulsivity and vulnerability to psychopathology. In T. P. Beauchaine & S. P. Hinshaw (Eds.), Child and adolescent psychopathology (pp. 129–156). Wiley.
Chamorro, J., Bernardi, S., Potenza, M. N., Grant, J. E., Marsh, R., Wang, S., & Blanco, C. (2012). Impulsivity in the general population: A national study. Journal of Psychiatric Research, 46(8), 994–1001. https://doi.org/10.1016/j.jpsychires.2012.04.023
Linehan, M. M. (1987). Dialectical behavior therapy for borderline personality disorder: Theory and method. Bulletin of the Menninger Clinic, 51(3), 261–276.
Murphy, C., & Mackillop, J. (2012). Living in the here and now: Interrelationships between impulsivity, mindfulness, and alcohol misuse. Psychopharmacology, 219(2), 527–536. https://doi.org/10.1007/s00213-011-2573-0
Orwin, R. G. (1994). Evaluating coding decisions. In H. Cooper & L. V. Hedges (Eds.), The handbook of research synthesis (pp. 139–162). Sage Publications.
Palili, A., Kolaitis, G., Vassi, I., Veltsista, A., Bakoula, C., & Gika, A. (2011). Inattention, hyperactivity, impulsivity—Epidemiology and correlations: A nationwide Greek study from birth to 18 years. Journal of Child Neurology, 26(2), 199–204. https://doi.org/10.1177/0883073810379640
Keep Learning
Below are some potential Socratic questions for class discussion of this paper:
- What are the key differences between impulsivity and mindfulness in terms of how they impact attention, awareness, and behavioral responses? How might increasing mindfulness skills help reduce impulsivity?
- This review found preliminary evidence for mindfulness as a stand-alone treatment for impulsivity. What do you see as the most important next steps for researchers to definitively establish the effectiveness of mindfulness in treating impulsivity?
- Imagine you are a clinician and one of your clients is struggling with significant impulsivity that is negatively impacting their life. Based on the findings of this review, would you feel confident recommending or providing a mindfulness-based treatment? Why or why not?
- Impulsivity is a transdiagnostic trait that shows up across many different mental health conditions. What are the potential advantages and disadvantages of targeting impulsivity directly with a focused treatment like mindfulness rather than addressing it in the context of disorder-specific interventions?
- Several studies in this review found no significant benefit of mindfulness over alternative treatments in reducing impulsivity. How do these findings influence your perspective on mindfulness-based interventions? What additional evidence would you need to consider mindfulness a first-line treatment option?
