HOMEWORK 5 (Total 100 points – 25 points each) 1. (Ch

HOMEWORK 5 (Total 100 points – 25 points each)
1. (Chapter 9, Question 2) Select an industry and analyze its
regionalization
drivers as they were five years ago, as they are today, and as
they are likely to be in
five years’ time.
2. (Chapter 9, Question 3) How should a company decide when
to use regional
rather than global strategies?
3. (Chapter 10, Question 2) Which industry globalization
drivers are the easiest to
measure, and which are the most difficult? What is the basi s for
your assertion?
4. (Chapter 10, Question 3) How often and by whom should
measures of
globalization and global strategy be made?
Mindfulness Research in Social Work:
Conceptual and Methodological

Recommendations
Eric L. Garland
Mindfulness refers to a set of practices as well as the
psychological state and trait produced
by such practices. The state, trait, and practice of mindfulness
may be broadly characterized
by a present-oriented, nonjudgmental awareness of cognitions,
emotions, sensations, and
perceptions without fixation on thoughts of past or future.
Research on mindfulness has
proliferated over the past decade. Given the explosion of
scientific interest in this topic,
mindfulness-based therapies are attracting the attention of
clinical social workers, who seek
to implement these interventions in numerous practice settings.
Concomitantly, research on
mindfulness is now falling within the scope and purview of
social work scholars. In response
to the growing interest in mindfulness within academic social
work, the present article
outlines six conceptual and methodological recommendations
for the conduct of future
empirical studies on mindfulness. These recommendations have
practical importance for
advancing mindfulness research within and beyond social work.
KEY WORDS: evidence-based practice; meditation;
mindfulness; randomized controlled trial; research methods
Mindfulness is linked with a set of cross-cultural principles and
practices origi-nating in Asia more than 2,500 years
ago that have parallel manifestations in numerous
cultures around the world. With regard to its cur-
rent academic usage, mindfulness refers to a psycho-

logical phenomenon that is now being studied for
its relevance to mental and physical health in fields
such as medicine, psychology, and neuroscience.
Across these fields, there is a growing body of litera-
ture that attests to the efficacy of mindfulness-based
therapies for a wide range of biobehavioral disorders.
According to a search of PubMed and CRISP data-
bases conducted on October 4, 2009, there were
1,614 peer-reviewed journal articles on mindfulness
published in the scientific literature and 320 research
grants on mindfulness funded by the National Insti-
tutes of Health between 1998 and 2009. Indeed,
there is mounting empirical evidence of the role of
mindfulness in reducing stress and improving clinical
outcomes across diverse conditions such as depres-
sion (Teasdale et al., 2002), relationship difficulties
(Carson, Carson, Gil, & Baucom, 2004), irritable
bowel syndrome (Gaylord et al., 2011), crimi-
nal recidivism (Himelstein, 2011), chronic pain
(Rosenzweig et al., 2010), and addiction (Bowen
et al., 2006; Garland, Gaylord, Boettiger, & Howard,
2010). Consequently, mindfulness-based interven-
tions are becoming well-regarded for their therapeu-
tic promise, as evidenced by recent publications in
mainstream, respected academic outlets, such as the
Journal of the American Medical Association (for exam-
ple, Ludwig & Kabat-Zinn, 2008).
Given this burgeoning interest, mindfulness-
based interventions are attracting the attention of
clinical social workers who are increasingly imple-
menting these treatments across diverse domains of
practice. Concomitantly, research on mindfulness
is now falling under the purview of social work
scholars, many of whom seek to determine the

comparative effectiveness of mindfulness-based
interventions and apply the construct of mindful-
ness to theories and models of social work practice.
In response to the growing interest in mindfulness
within academic social work, this article outlines
six conceptual and methodological recommenda-
tions for the conduct of future empirical research
on mindfulness.
INCREASE PRECISION IN
OPERATIONALIZATION OF THE CONSTRUCT
OF MINDFULNESS
To advance any field of scholarship, the precise
operationalization of constructs is a necessary first
doi: 10.1093/swr/svt038 © 2013 National Association of Social
Workers 439
step. Without such precision, empirical investiga-
tions of putatively identical phenomena may result
in widely divergent correlations between constru-
cts of interest and inconsistent clinical outcomes
across studies. Ultimately, imprecise operationaliza-
tion of constructs presents a severe threat to validity
that can undermine the quality of otherwise
well-designed research studies (Shadish, Cook, &
Campbell, 2002). Mindfulness research within and
outside of social work has been rife with this prob-
lem. An examination of Hick’s (2009) edited vol-
ume Mindfulness and Social Work clearly demonstrates
this issue. According to Hick, mindfulness is “an
orientation to our everyday experiences” (p. 1); to
others in the edited volume, it is a “specific and
effective method of focusing the mind on the ess-

ence of experience” (p. 45), a way to “mediate the
development of professional self-concept” (p. 93),
“an approach for increasing awareness” (p. 125),
an approach for “performing all activities with full
awareness” (p. 154), and even a “necessary condi-
tion for an activist to become mature in her passion
and mission to fight for justice” (p. 178). This lack
of conceptual clarity should be rectified and a uni-
form, coherent set of definitions established, if mind-
fulness research within social work is to advance.
To that end, the following operationalizations of
mindfulness are offered. First, mindfulness is a state,
a naturalistic mindset characterized by an attentive
and nonjudgmental metacognitive monitoring of
moment-by-moment cognition, emotion, percep-
tion, and sensation without fixation on thoughts of
past and future (Garland, 2007; Lutz, Slagter,
Dunne, & Davidson, 2008). Mindfulness is meta-
cognitive in the sense that it involves a meta-level
of awareness that monitors the content of con-
sciousness while reflecting back upon the process
of consciousness itself (Nelson, Stuart, Howard, &
Crowley, 1999). Mindfulness is naturalistic in that
it is a basic and inherent capacity of the human
mind, although people differ in their ability and
willingness to actualize this state (Brown, Ryan, &
Creswell, 2007; Goldstein, 2002).
Second, mindfulness is a practice (or, more accu-
rately, a set of practices) designed to evoke and fos-
ter the state of mindfulness. The practice of
mindfulness involves repeated placement of atten-
tion onto an object while alternately acknowledg-
ing and letting go of distracting thoughts and
emotions. Objects of mindfulness practice can

include the sensation of breathing; the sensation of
walking; interoceptive (Craig, 2003) and proprio-
ceptive (Brodal, 2004) feedback about the body’s
internal state, movement, and position; visual stim-
uli such as a candle flame or running water; mental
contents such as thoughts or feelings; or the quality
of awareness itself (Lutz et al., 2008). These prac-
tices are taught and trained in mindfulness-based
interventions.
Third, mindfulness is a trait or disposition that
may be developed over time through the repeated
practice of engaging in the state of mindfulness.
This trait may be characterized as the propensity
toward exhibiting nonjudgmental, nonreactive
awareness of one’s thoughts, emotions, experi-
ences, and actions in everyday life (Baer, Smith,
Hopkins, Krietemeyer, & Toney, 2006). As a trait,
mindfulness is roughly normally distributed (Walach,
Buchheld, Buttenmüllerc, Kleinknechtc, & Schmidta,
2006). People vary in the extent to which they
exhibit mindful dispositions, yet this dispositional-
ity can be strengthened through training. People
who participate in mindfulness-based interventions
evidence increases in trait mindfulness, which med-
iates the effects of training on clinical outcomes
(Carmody & Baer, 2008).
Thus, integral to mindfulness is the notion of
state by trait interaction, that is, recurrent activation of
the mindful state via mindfulness practices leaves
lasting traces that may accrue into durable changes
in trait mindfulness (Garland, Fredrickson, et al.,
2010), possibly mediated through neuroplasticity
and experience-dependent alterations in gene

expression (Garland & Howard, 2009). Indeed,
recent research suggests that mindfulness practice
can lead to increases in grey matter density in parts
of the brain that subserve emotion regulation,
learning, memory, and the ability to shift one’s
perspective (Holzel et al., 2011). More research is
needed to determine whether such neurobiologi-
cal changes index the development of trait mind-
fulness over time resulting from mindfulness
training.
USE RANDOMIZED CONTROLLED DESIGNS
WHEREVER POSSIBLE
A large number of social work studies use nonex-
perimental and quasi-experimental research designs
that are subject to severe threats to internal validity
(Shadish et al., 2002). Despite the presence of these
threats, authors often overstep the data by making
causal claims from what are, at best, descriptive or
440 Social Work Research Volume 37, Number 4 December
2013
correlational findings. Studies that attempt to test
causal hypotheses (for example, hypotheses of
therapeutic efficacy) using suboptimal research
designs weaken the portfolio of social work
research and lower the esteem of the profession in
interdisciplinary venues.
This is an especially serious problem when it
comes to research on mindfulness, which is still
met with skepticism within many academic circles
as a “New Age” or “mystical” practice that

amounts to little more than a placebo. Hence, it is
essential to use research designs in mindfulness
research that can control for the effects of matura-
tion, social desirability, expectancy, and placebo
effects.
From 1990 through the early 2000s, many stud-
ies on mindfulness used randomized wait-list con-
trol groups (for example, Astin, 1997; Davidson
et al., 2003; Shapiro, Schwartz, & Bonner, 1998;
Speca, Carlson, Goodey, & Angen, 2000). This
type of research design is capable of controlling for
history and maturation threats to validity as well as
creating statistically comparable groups at baseline,
and thus it represents a significant advance over
nonrandomized or quasi-experimental studies with
comparison groups. Yet, wait-list controlled designs
remain vulnerable to threats to validity stemming
from expectancy and placebo effects, which can be
substantial (Shapiro, 1981).
Given these concerns, for much of the past dec-
ade, mindfulness researchers have used randomized
controlled trial designs in which participants are
randomly assigned to either a mindfulness-based
intervention or a credible, therapeutically active
control condition. Perceived intervention credibil-
ity can be measured with self-report scales, such as
Borkovec and Nau’s (1972) Attitudes Towards
Treatment Questionnaire, and statistically con-
trolled (if necessary) in analyses of covariance. Such
scales contain items assessing the extent to which
the research interventions are perceived to be logi-
cal treatments for the targeted clinical condition
and how confident participants are that they will
reduce their symptoms. Ideally, participants would

perceive control treatments to be equally credible
to experimental mindfulness interventions (for
example, Garland, Gaylord, et al., 2010; Gaylord
et al., 2011). Expectancy effects can also be mini-
mized through careful advertising of the research.
For example, a flyer that contains the statement
“We are conducting research on mindfulness-
based treatments for cocaine addiction” is in-
herently flawed, as it suggests the treatment of
interest or preference and potentially introduces
expectancy effects that may confound study re-
sults. In contrast, research advertisements should
conceal the identity of the experimental and
control treatments. For instance, the same flyer
would minimize expectancy effects by stating,
“We are conducting research to compare the eff-
ectiveness of two forms of treatment for cocaine
addiction: a mindfulness-based treatment and a
support group.”
Moreover, the presence of significant main
effects of time on clinical outcome variables sug-
gests that the control condition may have been
therapeutically active; yet, the presence of a signifi -
cant Treatment × Time interaction term in the
hypothesized direction indicates that the experi-
mental mindfulness treatment led to significantly
larger therapeutic change over time than the con-
trol treatment. For example, in a randomized con-
trolled trial of psychosocial treatments for irritable
bowel syndrome, Gaylord et al. (2011) found that
participants in a mindfulness training intervention
and a conventional support group experienced sig-
nificant reductions in abdominal pain; yet, relative
to those in the support group, participants in the

mindfulness training intervention experienced sig-
nificantly greater reductions over the course of
training.
The use of credible, therapeutically active con-
trol groups may eliminate confounds introduced
by expectancy and placebo effects as well as
other nonspecific therapeutic factors such as atten-
tion by a caring professional, group dynamics, soc-
ial support, empathy, and the therapeutic alliance
(Castonguay, Goldfried, Wiser, Raue, & Hayes,
1996; Duncan, Miller, & Sparks, 2007). When a
study of a mindfulness-based intervention identi-
fies significant clinical outcomes within the con-
text of this rigorous research design, it may provide
evidence against the “Dodo bird verdict” (for a re-
view, see Budd & Hughes, 2009).However, it should
be noted that a study comparing a mindfulness-based
intervention to a no-treatment control is asking a
substantively different question than a study com-
paring a mindfulness-based intervention to an
active placebo control condition. In the former
case, the design allows one to measure the efficacy
of participation in a mindfulness-based interven-
tion; whereas in the latter case, the design allows
Garland / Mindfulness Research in Social Work 441
one to measure the efficacy of the active ingredient
in a mindfulness-based intervention, that is, the
practice of mindfulness itself. It should be noted
that many active control conditions are not merely
placebo controls, but instead are legitimate, estab-
lished treatments. For example, Kuyken et al.

(2008) compared mindfulness-based cognitive
therapy (MBCT) to maintenance of antidepressant
medication as a means of preventing depression
relapse. Thus, studies that use an active control
group can ascertain whether mindfulness training is
“more effective” than alternative treatments, in
contrast to studies with a no-treatment control
condition that answer the more basic question,
“Is participation in a mindfulness-based interven-
tion associated with positive clinical outcomes?”
This is not to say that nonexperimental
research designs have no place in mindfulness
research. To the contrary, much can be learned
about the associations between trait mindfulness
and related constructs using cross-sectional or
longitudinal research. However, it is imperative
that authors draw careful conclusions that do not
overstep the data. For instance, a prospective
observational study of 339 individuals undergoing
a mindfulness-based stress and pain management
course found that participants reported significant
improvements in trait mindfulness, positive reap-
praisal coping, catastrophizing, and perceived stress
over eight weeks of training (Garland, Gaylord,
& Fredrickson, 2011). Further, the association
between increases in trait mindfulness and decreases
in stress was partially mediated by increases in posi -
tive reappraisal but not by decreases in catastroph-
izing. Although these findings are potentially
clinically useful, one cannot conclude that mind-
fulness training caused the observed changes. At
best, one can only conclude that these changes
occurred while participants were engaged in a
mindfulness training program. Findings such as
these are relevant only to the extent that they

are interpreted with great precision; otherwise,
they will remain unpublished or, worse, be pub-
lished and tarnish the reputation of mindfulness
researchers within and beyond academic social
work.
Several key observational, quasi-experimental,
and experimental research studies that represent
the broad scope of research on mindfulness as a
state, trait, and practice are presented in Table 1.
INVESTIGATE THERAPEUTIC MEDIATORS
AND USE DISMANTLING DESIGNS
Social work, as an applied field, is often myopically
focused on clinical outcomes to the exclusion of
more basic forms of scientific research. However,
asking the question “By what processes does this
treatment work?” is often a key step in refining and
optimizing an intervention (Kazdin & Kendall,
1998; Kraemer, Wilson, Fairburn, & Agras, 2002).
For instance, if an initial study reveals that increases
in trait nonreactivity mediate the therapeutic effect
of mindfulness training on chronic pain (compare,
Garland, Gaylord, Palsson, et al., 2012), mindful-
ness interventions tested in future clinical research
projects might emphasize techniques designed to
increase nonreactivity in order to boost treatment
effect sizes. Thus, examining therapeutic mediation
could enable social work researchers to determine
how mindfulness-based interventions might be
targeted most effectively to the populations and to
identify problems of greatest interest to clinical
social workers in the field. Therapeutic mediation
can be tested by a number of statistical methods, in-
cluding canonical regression procedure (Baron &
Kenny, 1986), bootstrapping (Preacher & Hayes,

2004), structural equation modeling (Kline, 1998), or
latent growth curve approaches (Preacher, Wichman,
MacCallum, & Briggs, 2008), among others.
Moreover, by establishing the mediators of treat-
ment, one can assess whether a treatment is inter-
nally consistent with the theoretical orientation in
which it is grounded (Hayes, Strosahl, & Wilson,
1999). This is important, both for maintaining the-
oretical coherence and preventing reductionism
and subsequent dismissal by researchers operating
from other theoretical orientations. As one promi-
nent example of this issue, mindfulness practices
have been construed by some as relaxation tech-
niques, believed to reduce stress via evocation of a
relaxation response (Benson, Beary, & Carol,
1974). However, mindfulness meditation has been
shown to produce significantly different cardiovas-
cular and autonomic effects than relaxation training
(Ditto, Eclache, & Goldman, 2006), findings that
argue against the reductionistic construal of mind-
fulness practice as a mere relaxation technique. Fur-
ther, a randomized controlled trial demonstrated that
whereas both mindfulness practice and relaxation
training led to reduced distress, mindfulness practice
alone led to significant decreases in ruminative
2013
Table 1: Select Key Studies Representing the Broad Scope of
Research on Mindfulness as a State, Trait, and Practice
Study Sample Design

Operationalization of Mindfulness
or Related Phenomena Pertinent Results
Bowen et al.
(2009)
168 adults with substance use
disorders
RCT of MBRP versus
standard substance use
treatment services
Trait mindfulness assessed by the FFMQ;
acceptance assessed by the AAQ
MBRP participants, relative to the control group, reported
significantly
fewer days of drug and alcohol use. Relative to the control
group,
MBRP led to significant increases in acceptance and the Acting
with
Awareness subscale of the FFMQ.
Carmody &
Baer (2008)
174 adults with a wide range of
stress, chronic pain, and
anxiety issues
Prospective observational
study of MBSR

time spent in formal mindfulness
practice
Increases in trait mindfulness were significantly associated with
time
spent in formal mindfulness practice. Increases in trait
mindfulness
mediated the effects of time spent in mindfulness practice on
psychological symptoms, stress, and well-being.
Feldman,
Greeson, &
Senville
(2010)
190 female college students Random assignment to 15
minutes of MT, LKM,
or PMR
State mindfulness (decentering) assessed by
the TMS; frequency of or reactivity to
repetitive thoughts
MT participants reported significantly greater state mindfulness
(decentering) relative to the other two conditions. Relative to
the
other conditions, a 15-minute session of MT reduced negative
reactions to repetitive thoughts.
Garland,
Gaylord,
et al. (2010)
53 alcohol-dependent adults in
long-term residential
treatment

RCT of MORE versus an
addiction support group
Thought suppression (that is, a construct
that is the opposite of mindfulness)
assessed by the WBSI
MORE participants, relative to those in the support group,
experienced
significantly larger decreases in stress and thought suppression.
Among MORE participants, decreases in thought suppression
were
associated with decreased fixation on alcohol cues and
increased heart
rate variability recovery from stress and alcohol cues.
Gaylord et al.
(2011)
75 female patients with
irritable bowel syndrome
RCT of MT versus a
support group
Trait mindfulness assessed by the FFMQ MT participants,
relative to those in the support group, experienced
significantly decreased abdominal pain and increased quality of
life.
The effect of MT on these clinically significant outcomes was
mediated by increases in trait mindfulness (nonreactivity).a
Holzel et al.
(2011)

33 healthy adults either
participating or waiting to
participate in a MBSR
course
Quasi-experiment
comparing MBSR to
wait-list control group
changes in brain structure assessed by
structural magnetic resonance imaging
MBSR participants, relative to those in the wait-list control
group,
reported significant increases in trait mindfulness and exhibited
significant increases in grey matter concentration in left
hippocampus, cingulate cortex, cerebellum, and temporo-
parietal
junction.
Kuyken et al.
(2010)
123 patients treated with
antidepressants who had ≥ 3
depressive episodes
RCT of MBCT versus
continued
antidepressants
Trait mindfulness assessed with the KIMS;
self-compassion assessed with the SCS
The therapeutic effects of MBCT were mediated by increases in

trait
mindfulness and self-compassion over the course of treatment.
MBCT moderated the association between cognitive reactivity
and
depression.
Teasdale et al.
(2002)
100 patients in remission or
recovery from major
depression
RCT of MBCT versus
treatment as usual (for
example, doctor)
Metacognitive awareness assessed by the
MACAM
MBCT participants, relative to the control group, experienced
significantly fewer occurrences of depression relapse. MBCT
led to
significantly increased metacognitive awareness.
Notes: MBRP = mindfulness-based relapse prevention; AAQ =
Acceptance and Action Questionnaire (Hayes et al., 2004);
FFMQ = Five-Facet Mindfulness Questionnaire (Baer et al.,
2006); LKM = loving-kindness meditation; KIMS = Kentucky
Inventory of Mindfulness
Skills (Baer, Smith, & Allen, 2004); MACAM = Measure of
Awareness and Coping in Autobiographical Memory (Moore,
Hayhurst, & Teasdale, 1996); MBCT = mindfulness-based
cognitive therapy; MBSR = mindfulness-based stress reduction;
MORE = mindfulness-oriented recovery enhancement; MT =
mindfulness training; PMR = progressive muscle relaxation;

RCT = randomized controlled trial; SCS = Self-Compassion
Scale (Neff, 2003); TAU = treatment as usual; TMS = Toronto
Mindfulness Scale (Lau et al.,
2006); WBSI = White Bear Suppression Inventory (Wegner &
Zanakos, 1994).
a These mediational data are presented in Garland, Gaylord,
Palsson et al. (2012).
G
arlan
d
/
M
indfulnessR
esearch
in
SocialW
ork
443
thoughts that partially mediated its therapeutic effect
on distress (Jain et al., 2007). Such results suggest that
mindfulness practice exerts therapeutic effects by
modifying cognitive processes, a finding that accords
with extant theory on mindfulness.
It is also crucial to prevent the obscurations of
eclecticism that can confound attempts to establish
the efficacy of specific intervention techniques.
Although treatments that have received robust
empirical support, such as cognitive behavior ther-

apy (CBT), use multiple modes of intervention
(for example, CBT includes cognitive restructur-
ing, behavioral activation, exposure, behavioral
experiments, and other techniques), research on
multimodal treatment packages remains subject to
criticism. For instance, Longmore and Worrell
(2007) review evidence that the addition of cogni-
tive restructuring to behavioral activation tech-
niques does not significantly increase treatment
effects, suggesting that the cognitive component of
CBT is neither necessary nor sufficient for thera-
peutic change. The most commonly researched
form of mindfulness training, mindfulness-based
stress reduction (MBSR) (Kabat-Zinn, 1990), is
also a multimodal treatment, which uses both
mindfulness techniques and hatha yoga postures.
Although the efficacy of MBSR has been estab-
lished in a number of trials (Chiesa & Serretti,
2009), it remains to be seen whether the therapeu-
tic effects of the program derive more from its
mindfulness or yoga components. To that end, dis-
mantling studies are needed that partial out the
differential effects of mindfulness treatment com-
ponents by randomly assigning participants to
receive one or more aspects of the multimodal
intervention package (Shadish et al., 2002). How-
ever, it is important to note that multimodal treat-
ments are designed to promote synergistic effects
by using different techniques that when combined
produce more powerful clinical outcomes than the
individual approaches alone (for an example of a
recent multimodal mindfulness intervention, see
Garland, 2013). As such, dismantling studies are
needed to complement, rather than supplant, research
on multimodal mindfulness-based interventions.

USE BEHAVIORAL AND PHYSIOLOGICAL
MEASURES OF MINDFULNESS AND
THERAPEUTIC CHANGE
As interest in mindfulness grows, there is a need to
further specify and operationalize the measurement
of mindfulness and its therapeutic effects in both
clinical and basic science research programs. A
number of questionnaires currently are used to
quantify both state and trait mindfulness in studies,
such as the Five-Facet Mindfulness Questionnaire
(Baer et al., 2006) and the Toronto Mindfulness
Scale (Lau et al., 2006). Although these scales can
be useful, measurement instruments that rely on
self-report are vulnerable to reactivity to being in
an experimental condition, experimenter expec-
tancies, social desirability biases, and misinterpreta-
tion of question items (Shadish et al., 2002).
Moreover, it should be recognized that question-
naire items are proxies for latent variables that can
only imperfectly capture the essence of the con-
struct under investigation (DeVellis, 2003). Any
one operationalization may inadequately represent
the construct of interest (Shadish et al., 2002).
As such, research on mindfulness as a state, trait, or
practice that solely relies upon self-report instru-
ments is subject to the same social influences and
mono-operation biases as research on other psy-
chosocial phenomena.
To counter the limitations of self-report mea-
sures, mindfulness researchers may benefit from
using behavioral and physiological measures of
mindfulness and its therapeutic effects. In the past
decade, there has been an explosion of studies in
the psychological, medical, and neuroscientific lit-

erature investigating the therapeutic mechanisms of
mindfulness using an array of sophisticated research
methodologies, including cognitive tasks (for ex-
ample, Garland, Boettiger, Gaylord, West Chanon,
& Howard, 2012; Zeidan, Johnson, Diamond,
David, & Goolkasian, 2011), psychophysiological
measures (for example, Garland, 2011; Ditto et al.,
2006), and neuroimaging techniques (for example,
Farb et al., 2010; Froeliger, Garland, Modlin, &
McClernon, 2012). Yet, in spite of the application
of ever-increasing methodological rigor to research
on mindfulness in these fields, few social work
scholars have dared to tread into this domain.
Whereas the implementation of many of biobeha-
vioral methods (such as functional magnetic reso-
nance imaging or DNA microarrays) requires years
of specialized training not offered in most social
work doctoral programs, other methods, such as the
measurement of heart-rate variability, cortisol assays,
and certain performance-based tasks derived from
cognitive neuroscience, may be within reach of a
wider range of social work researchers.
2013
The use of such measures not only helps probe
into questions of mechanism, but also provides a
means with which to triangulate self-reports of
change. For instance, Garland, Gaylord, et al. (2010)
conducted a randomized controlled pilot trial com-
paring the efficacy of a novel mindfulness-oriented
cognitive intervention, mindfulness-oriented recovery
enhancement (MORE), to that of an addiction

support group for persons in long-term recovery
from alcohol dependence. Results indicated that,
relative to the support group, MORE led to signif-
icant reductions in self-reported stress and thought
suppression, but no changes in craving were obser-
ved. This null finding might have suggested that
this mindfulness-based intervention, although gen-
erally therapeutically active, did not lead to changes
addiction-specific factors. Yet, many clients in re-
covery are resistant to the term “craving” and are ret-
icent to endorse experiencing it, particularly those in
long-term residential treatment where the pressure
to conform to social, cultural, and programmatic
mores is high. Fortunately, non-self-report measures
of alcohol cue-reactivity were assessed, including a
dot probe task and a psychophysiological protocol,
which determined the degree to which participants’
attention was fixated on alcohol cues and the extent
of heart-rate variability recovery from alcohol cue-
exposure, respectively. MORE was found to modify
both of these attentional and autonomic mechanisms
implicated in alcohol dependence, suggesting that
mindfulness training does in fact exert addiction-
specific therapeutic effects. Moreover, individual
difference analyses of change scores revealed that
among participants in the mindfulness intervention,
reductions in self-reported thought suppression were
correlated with decreases in attentional fixation on
alcohol cues and increases in heart rate variability
recovery from such cues. Thus, in a biopsychosocial
research methodology, data from self-report mea-
sures, cognitive tasks, and psychophysiological meth-
ods converged in a theoretically sensible and mutually
informative manner.
Psychophysiological research notwithstanding,

investigators in a field as applied as social work
should take pains to carefully document the spe-
cific, behavioral outcomes of mindfulness as state,
trait, and practice. For instance, variables such as
frequency and duration of hospitalizations, number
of arrests, and latency to re-incarceration are clearly
quantifiable, clinically important, and reflective of
real-world intervention impacts. Researchers could
assess whether changes in more proximal psycho-
logical variables mediate the effect of mindfulness
practice on these distal clinical outcomes.
USE A MIXED-METHODS APPROACH
Although researchers are increasingly using more
rigorous methodologies to investigate mindfulness,
little is known about how individuals utilize mind-
fulness states, traits, and practices in their everyday
lives to cope with stressors and emotional chal-
lenges. Furthermore, the phenomenology of the
change process as persons undergo mindfulness
training remains unspecified. Although these areas
of inquiry are to some extent tractable to quantita-
tive research methods, they may also be fruitfully
addressed through qualitative means.
Insofar as mindfulness is a first-person phenome-
non, that is, one that is directly accessible only to
the person who is experiencing it (Depraz, Varela,
& Vermersch, 2003), first-person accounts are nec-
essary to capture the essence of the experience of
mindfulness as it is perceived by those participating
in mindfulness-based interventions. Grounded the-
ory analyses of qualitative data derived from these
reports may be used to triangulate etic theoretical
conceptualizations of mechanisms by which mind-

fulness facilitates coping (for example, Garland,
Schwarz, Kelly, Whitt, & Howard, 2012).
Data derived from in-depth interviews may be
integrated with data from psychometric instru-
ments, psychophysiological assessments, and so on.
Such a mixed-methods approach would capture
the interpenetrating qualitative and quantitative
aspects of mindfulness. One might, for example,
complement findings of mindfulness-induced
changes in physiological stress reactivity with a
“thick description” (Padgett, 1998) of how indi-
viduals exhibiting such changes have learned to
cope differently with distressing thoughts and
emotions after mindfulness training. To that end,
techniques such as protocol analysis (Ericsson &
Simon, 1993) can be useful to precisely elucidate
the mental steps and procedures taken by partici-
pants of mindfulness-based interventions as they
apply mindfulness skills to coping with adversity.
REMAIN MINDFUL OF CULTURAL AND
CONTEXTUAL CONSIDERATIONS
The Buddhist tradition from which mindfulness has
been abstracted is grounded in a sort of ecological sys-
tems theory, known as pratityasamutpada, sometimes
translated as interdependent co-arising or what the
venerable meditation teacher Thich Nhat Hanh
simply called “interbeing” (Hanh, 1988). Pratitya-
samputpada is the notion that all things are interre-
lated and depend on one another for their

existence. According to this notion, any being or
entity is in fact the summation of an infinite number
of causal forces extending from the past through the
present and into the future. For example, the life of a
human being in any given moment is influenced by
the state of the world in that moment, in turn com-
posed of environmental conditions, global and
national political structures, cultural traditions, eco-
nomic forces, community events, and social relation-
ships. However, in a reciprocal fashion, the state of
the world is conditioned by each human life; indeed,
our every action changes the shape and contour of
the world, in both a literal and figurative sense.
In light of these considerations, social work
researchers should remain mindful of the cultural
and contextual forces that influence the implemen-
tation and acceptability of mindfulness-based inter-
ventions and the state of mindfulness itself. Clinical
interventions are not delivered in a vacuum; they
are delivered in a social, cultural, economic, and
political context. It is notable that the overwhelm-
ing majority of studies on mindfulness have been
conducted with samples of white, middle- to upper-
class individuals. For example, of the eight studies
presented in Table 1, only the studies conducted by
Bowen et al. (2009) and Garland, Gaylord, et al.
(2010) included a racially and socioeconomically
diverse sample. Mindfulness may indeed have a dif-
ferent meaning for vulnerable persons facing pov-
erty, homelessness, violence, and trauma who do
not have the benefit of advanced education, eco-
nomic resources, or political capital. Social work
researchers are uniquely poised to assess interaction
effects between client characteristics, sociocultural
context, mindfulness training, and clinical outcomes.

Moderation analyses (Baron & Kenny, 1986) could
be used to determine the effects of mindfulness train-
ing on persons from different social strata and ethnic
backgrounds. Such population-specific data should
be integrated into a feedback loop that informs
implementation of mindfulness-based interventions
in the field. In addition, principles endorsed in treat-
ment manuals of mindfulness-based interventions
(for example, Garland, 2013) should be couched in
widely accessible vocabulary instead of sectarian and
academic jargon. These practices will lead to the
optimization of mindfulness-based interventions for
the focal populations and problems of interest to the
social work profession.
CONCLUSION
The past decade has witnessed a proliferation of
research on mindfulness, both within and beyond
social work. Studies of mindfulness-based therapies
may increasingly attract attention from the social
work profession inasmuch as they illuminate the
efficacy and cost-effectiveness of new forms of
intervention. For example, a randomized control-
led trial found that among persons in remission for
major depression, MBCT was more effective in
reducing residual depressive symptoms and improv-
ing quality of life than antidepressant medication,
yet was of comparable financial cost (Kuyken
et al., 2008). Moreover, mindfulness-based inter-
ventions may address emerging threats to public
health and social welfare; in that regard, a recent
early stage clinical trial identified significant thera-
peutic effects of MORE on co-occurring prescrip-
tion opioid misuse and chronic pain, a problem of
increasing medical and sociological significance

(Garland et al., 2013). In addition to its fiscal and
clinical efficacy, mindfulness is congruent with the
strengths-based approach and empowerment ethos
of social work. As a means of developing self-
regulatory capacity, mindfulness practices enhance
coping and thereby promote resiliency. Given the
natural fit between mindfulness and the overarching
practice philosophy of the social work profession,
there is a great need for social work researchers to
thoughtfully engage in this important domain of
inquiry.
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Eric L. Garland, PhD, is associate professor, College of Social
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Advance Access Publication December 19, 2013
2013
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Lexmark Restructuring
Lexmark International is a printer company with inkjet, laser,
and technology divisions. It is an international company with a

huge international presence. The history of Lexmark begins
with another company, IBM. The information products division
of IBM was sold in a downsizing and it became Lexmark ("Lex"
stands for "lexicon" and "mark" stands for "marks on paper").
This small piece of IBM was headed by Marvin Mann who
began an aggressive campaign to make Lexmark the undisputed
leader in innovative printing solutions. (3)
Lexmark is a company of firsts. Throughout their history they
have driven innovation. “Lexmark was the first company to
offer an inkjet printer for under $100 and were also the first to
promote a 4800 x 1200 dpi and a 3600 x1200 dpi resolution.
Keeping on the trend of "firsts" they were also the first
company to make a photo printer that could work on its own as
a standalone model.”(4)
The firsts were made possibly by expanding into different
international markets to take advantage of low priced labor
among other outsourcing benefits. “Lexmark operates
manufacturing control centers in Lexington, Kentucky;
Shenzhen, China; and Geneva, Switzerland; and has
manufacturing sites in Boulder, Colorado; Juarez and
Chihuahua, Mexico; and Lapu-Lapu City, Philippines.”(5)
Lexmark International is rightfully named given its obvious
involvement in several countries. However, despite many
challenges abroad a massive restructuring is the main focus of
the company today.
Lexmark is planning to discontinue all of its inkjet hardware,
development and manufacturing by the end of 2015. The
decision has come at a time that consumer printing is at an all-
time low. Inkjet hardware, development and manufacturing has
been a corner stone of Lexmark in the past. However, with
today’s consumer printing climate it simply does not make
sense fiscally for Lexmark to move forward with the inkjet
platform in any of its current forms.(5)
The hardware, referring to the physical printer, is sold at a net
profit loss. In theory, this loss is recuperated by selling
secondary needs such as ink cartridges. However, with less and

less printing being done by the home consumer it is
unjustifiable to sell negative margin hardware without ever
regaining the losses. Pertaining to the inkjet platform, Lexmark
has been steadily losing market share and profits since the year
2000 . The simple fact is people are not printing enough for
Lexmark to continue down the inkjet path or even home
consumer printing solutions. With the move to discontinue
inkjet printers Lexmark is making a more broad statement for
its future. Lexmark will be exiting the consumer printer market
altogether. The decision to drop the inkjet printer division is
simply the first major move toward this end game and move
toward focusing on high margin products.(2)(6)
The effects of this decision on Lexmark are immense; on both
the international and domestic front. Approximately 1,700
employees worldwide will be laid off during this particular
restructuring plan. “Lexmark's Philippines-based inkjet
supplies manufacturing facility will be shuttered by the end of
2015.”(1) These are major moves that come with major savings
for Lexmark as a whole. By the end of 2013 $85 million dollars
is expected to be saved solely by limiting inkjet development.
An additional $ 95 million dollars is expected to be saved
annually starting in 2015. These savings projections do not
include revenue generation from the selling of Lexmark’s
extensive inkjet patent portfolio. (1)
Paul Rooke, Lexmark chairman and chief executive officer
spoke about the decision to discontinue the inkjet line. "Today's
announcement represents difficult decisions, which are
necessary to drive improved profitability and significant
savings. Our investments are focused on higher value imaging
and software solutions, and we believe the synergies between
imaging and the emerging software elements of our business
will continue to drive growth across the organization. As we
move forward, we remain confident in our strategy,
competitiveness and ability to create value for shareholders."(5)
This statement by Paul Rooke says many things about Lexmark
International as a whole. The inkjet platform has served them

well for many years but as technology has changed so must
Lexmark. For this reason Lexmark is beginning to purchase
technology companies to focus on business printing solutions; a
much higher margin strategy. With inkjet printers no longer a
focus and drain on Lexmark’s profit margin and corporate
culture, dedication to pushing the edge of laser printing and
business solutions has been renewed.
As the inkjet platform is phased out of Lexmark’s line of
printers, technology is replacing it. Perceptive Software is a
business unit of Lexmark International. This unit of Lexmark
“builds process and content management software that closes
the information gaps that exist throughout every organization”
(8) The future of Lexmark is far more reaching than just laser
printing solutions. This competitive move they are making
utilizes many strengths of the already in place company.
“Powered by the financial strength and global reach of Lexmark
International, Perceptive Software offers a complete set of
process and content management software technology,
including, Business process management, enterprise content
management, intelligent data capture, enterprise and federated
search, integration technology. Powerful tools used alone, but
when combined with Perceptive’s keen understanding of your
people, processes and applications, they become
transformational solutions to your biggest business challenges.”
(8) It is obvious to see that Perceptive Software is becoming a
big player in the world of business solutions and Lexmark is
again on the cutting edge of not just printing solutions but
business solutions as a whole.
Lexmark and perceptive software have been busy. Purchasing
several different technology companies like Pallas Athena,
ISYS Search Software, Brainware and Nolij. These acquisitions
by Lexmark and their new focus on business performance
management solutions are repositioning the company. Not only
are they known for high quality printers, in the eyes of small
and very large businesses Lexmark is positioning as a total
solutions company for other companies who are looking to run

faster and more efficient. Because of the new direction
Lexmark stock prices have risen 17% since the exit of the inkjet
market. The overall health of the company is improving.
(10)(9)
Despite early numbers looking good for Lexmark’s new
direction there are massive hurdles yet to overcome, especially
in the business process management and IT solutions sector of
the market. One of their biggest challenges globally will be
global competition. Achievo Corporation, Aegis Limited,
Affinity Express, and Aditya Birla Minacs Worldwide Limited
are companies with well-known names worldwide for IT and
efficiency solutions. Competing with these names in the global
market is key for Lexmark. Ousting these companies out of
well entrenched markets will be very difficult for Lexmark to
do. A key to the success of Lexmark and Perceptive software is
to take the emerging markets. Emerging markets is where
Perceptive software will be able to combine business process
management IT solutions and printing solutions. It is a very
specialized skill set that every business needs and they are the
first company to combine and be specialized and innovative on
every one of these fronts. (9)
The effectiveness of Lexmark’s printing and software solutions
have been proven effective several times. AEG is an excellent
example of the effectiveness of Lexmark Perceptive software.
AEG manages stadiums including the YUM center in Louisville.
They process 250,000 invoices every year. Before Perceptive
Software was hired by AEG it took AEG 42 to 45 days to
process each one of those invoices. Not to mention postage fees
the company was incurring they were missing out on payment
period discounts and racking up late fees. Perceptive software
came in and built a new invoice system catering directly to the
specialized needs of AEG. The Lexmark and Perceptive
Software solution consisted of scanning the invoices making
them available everywhere on the AEG network and cut the
payment period down to 14 days. (6)(7)
Lexmark’s focus on business is pushing the company forward.

The focus on higher margin business solutions in both the areas
of Perceptive software and laser printing is moving the company
in an incredibly profitable direction. Without the weight of
inkjet hardware, development and manufacturing that has been
dragging Lexmark down since 2000 they are becoming a very
lean and focused company. Lexmark has recently rolled out 42
new laser printers demonstrating the importance of printing to
this company. Lexmark’s CEO Paul Rooke says it best, “For
any technology company to survive, you have to stay flexible
and listen well. If you get tied to your past, that can be a real
problem for your future.” Lexmark’s actions prove they are
committed to moving the company forward and are dedicated to
the new direction they have chosen to take.
References
1. http://www.pcmag.com/article2/0,2817,2408986,00.asp
2. http://articles.marketwatch.com/2012-08-

28/markets/33439500_1_lexmark-market-for-inkjet-printers-
inkjet-products
3. http://www.fundinguniverse.com/company-histories/lexmark-
international-inc-history/
4. http://printerinkcartridges.printcountry.com/printcountry-
articles/printer-company-histories-press-releases/the-history-of-
lexmark
5. http://www.engadget.com/2012/08/28/lexmark-restructuring-
plan-layoffs-inkjet-business/
6. http://www.kentucky.com/2012/12/02/2428753/lexmark-in-
midst-of-major-change.html
7.
http://newsroom.lexmark.com/index.php?s=13630&item=12475
0
8. http://www.perceptivesoftware.com/company/about/index
9. http://www.bpmwatch.com/knowledgebase/top-10-it-and-
bpm-companies-from-2012-gs-100-list/
10. http://buzz.money.cnn.com/2012/08/28/lexmark-stock/
1. (Chapter 7, Question1) What is the difference between a
multilocal and a global

approach to making competitive moves?
2. (Chapter 7, Question 3) What should be the response of a
company when a
foreign competitor is dumping in that company’s home market?
Would your answer
differ if the foreign competitor were (a) an exporter producing
only in its home
country or (b) a multinational company with production and
sales around the
world?
3. (Chapter 8, Question 3) What are the ways in which
management processes can
be used to implement global strategy?
4. (Chapter 8, Question 4) What are the ways in which human
resource policies
can be used to implement global strategy?
1. (Chapter 5, Question1) What is the difference between a
multilocal and a global
approach to locating value-adding activities?
2. (Chapter 5, Question 2) What is the difference between

strategic and
comparative bases of advantage?
3. (Chapter 6, Question 4) What elements of the marketing mix
are the easiest to
make global, and which are the hardest?
4. (Chapter 6, Question 5) When should a company use a global
brand name and
when should it use different local names?
1. (Chapter 3, Question1) What are the most important countries
in which a global
business should participate today, and why? What will this list
of countries look like
in 5 years’ time? What will it look like in 10 years’ time?
2. (Chapter 3, Question 2) How should a company select
countries for market
participation?
3. (Chapter 4, Question 1) What is the difference between a
local product and a
global product?

4. (Chapter 4, Question 6) Which service elements are easier to
standardize
globally?
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HOMEWORK 5 (Total 100 points – 25 points each) 1. (Ch

HOMEWORK 5 (Total 100 points – 25 points each) 1. (Ch

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