Que mesurent les échelles psychologiques de pleine conscience ?

La recherche sur la pleine conscience nécessite de définir très précisément ce que c’est. Or c’est encore loin de faire consensus comme le relève un article récemment publié (Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation). Si les types de méditation et d’intervention sont mieux distingués, l’état psychologique qui est supposé en résulter est plus difficile à circonscrire. Cela affecte la validité de construit en psychométrie.

9 échelles de mesure de la pleine conscience / mindfulness

Voici une liste de 9 échelles de mesure de la pleine conscience / mindfulness avec leurs contextes théoriques, leur nombre de citations (popularité d’utilisation) et les facteurs psychologiques mesurés.

Il existe d’autres échelles générales non citées comme l’Applied Mindfulness Process Scale (AMPS) ou le Mindfulness Questionnaire (MQ) de Chadwick et al. par exemple.

On trouve ainsi les capacités ou facteurs suivants :

  1. conscience (5)
  2. acceptation (3)
  3. observation (2)
  4. description (2)
  5. attention (attentiveness ou attention) (2)
  6. non-réactivité
  7. non-jugement
  8. curiosité
  9. décentration
  10. focalisation sur le présent

Une autre étude répertorie 11 échelles de mesure de pleine conscience validées (en anglais) :

extrait de Im, Sungjin. (2017). What Is Measured by Self-report Measures of Mindfulness?: Conceptual and Measurement Issues. in Handbook of Zen, Mindfulness, and Behavioral Health (pp.215-235)

Qualités psychométriques des échelles de pleine conscience

extrait de Qual Life Res. 2013 December ; 22(10): . doi:10.1007/s11136-013-0395-8

Mindfulness: A systematic review of instruments to measure an emergent patientreported outcome (PRO)
par Taehwan Park1, Maryanne Reilly-Spong1, and Cynthia R Gross1

Mindfulness Attention Awareness Scale (MAAS)

The MAAS was the first widely-disseminated measure of mindfulness. It was designed to
measure mindfulness as present-centered attention-awareness in everyday experience, a state
which varies within and between persons, and an attribute that may be cultivated with
practice [15]. This instrument focused on the absence of attention to and awareness of
present experience, and was designed to operationalize mindfulness as a single construct.
This instrument was intended to be generic, and applicable to persons regardless of
experience with meditation. Sample items are shown in Table 4. Most studies confirmed a 1-
factor structure for the MAAS [15,39-42]. One study found that some items in the MAAS
did not function well as indicators for a single latent construct [43]. There was support for
the internal consistency of the MAAS (Cronbach alphas ranging from 0.78 to 0.92) and
evidence of test-retest reliability (ICC = 0.81). Correlations between the MAAS and other
mindfulness instruments, such as the FMI, CAMS-R, SMQ, KIMS, and MMS, were weak to
moderate (r’s = 0.14 to 0.51) [15,44,45]. Consistent with expectations for construct validity,
MAAS scores were positively correlated with measures of openness, internal state
awareness, positive and pleasant affect, and well-being, and negatively correlated with
neuroticism, anxiety, stress, and rumination [15,39,44-47]. MAAS scores were higher for
meditators compared to non-meditators [43], but there was no significant difference between
novice meditators and non-meditators [40]. Several studies [15,48,49] have compared the
MAAS to results on performance-based tasks (e.g., cognitive tests of attention, inhibition)
with mixed results.

Kentucky Inventory of Mindfulness Skills (KIMS)

The KIMS was designed to assess the tendency to be mindful in daily life in areas
corresponding to the skills taught in mindfulness interventions, particularly Dialectical
Behavior Therapy [50]. The KIMS consists of 39 items grouped into four subscales:
Observe, Describe, Act with Awareness, and Accept without Judgment. The Observe
subscale reflects the skill of observing or paying attention to internal (bodily sensations, thoughts and emotions) and external phenomena. The Describe subscale refers to a tendency
or ability to put sensations, perceptions, thoughts, feelings, emotions, or experiences into
words. The Act with Awareness subscale reflects the ability to focus undivided attention on
the present. The Accept without Judgment subscale includes both the act of making
judgments and common examples of self-criticism. The 4-factor structure of the KIMS was
supported by exploratory factor analysis (EFA); 43% of the variance was accounted for by
the 4-factors [50]. Although nearly adequate fit was shown in confirmatory factor analysis
(CFA), the analyses used a somewhat controversial “parceling approach” to overcome CFA
sample size limitations, and others were unable to replicate the 4-factor solution by EFA
[41]. The KIMS (global and subscales) had evidence of internal consistency (Cronbach
alphas ranging from 0.72 to 0.97), and test-retest reliability was adequate (r’s ranging from
0.81 to 0.86) for all but the Observe subscale (r = 0.65) [50]. The construct validity of the
KIMS global score was supported by moderate correlations (r’s ranging from 0.51 to 0.67)
with the MAAS, FMI and CAMS-R and positive correlations with meditation experience
[44]. Consistent with expectations for convergent and divergent validity, the global KIMS
had positive correlations with openness, emotional intelligence, and self-compassion, and
negative correlations with psychological symptoms, neuroticism, alexithymia, dissociation,
and absent-mindedness [44]. KIMS subscales had different levels of evidence to support
their construct validity. Accept without Judgment has consistently been found to be the most
robust subscale, with most a priori relationships with health and quality of life measures
confirmed [45,47,50-52]. There was also moderate evidence of the construct validity of the
Act with Awareness subscale. Evidence to support the construct validity of the Describe
subscale was limited, and relationships with the Observe subscale have been unpredictable.
For example, the Observe subscale did not differ between adults with borderline personality
disorder and normative student samples [50]. The developers acknowledged limitations in
the content coverage of the KIMS, and concerns about integration of the subscales to
provide a meaningful global score.

Freiburg Mindfulness Inventory (FMI)

The FMI was originally developed and validated in German, and English translations of
FMI items have been incorporated into more recently developed mindfulness instruments
[44]. Buddhist psychology guided development of the FMI and its intended target audience
was individuals with some knowledge about or familiarity with insight meditation. The FMI
was designed to assess mindfulness as “attentional, unbiased observation of any
phenomenon in order to perceive and to experience how it truly is, absent of emotional or
intellectual distortion” [53]. The developers cited the hallmark of mindfulness as
dispassionate, non-manipulative participant observation of ongoing mental states without
conceptualizing or forming emotional reactions. EFA identified 4 factors for the FMI,
however the structure was not stable across samples and items cross-loaded, which the
authors interpreted as support for a single underlying factor [53]. This original 4-factor
structure was only approximately replicated in a subsequent study [54], and these authors
also favored interpreting the FMI as one general factor reflecting mindfulness. There was
evidence to support the internal consistency of the global FMI (Cronbach alphas ranged
from 0.80 to 0.94). The FMI had weak to moderate correlations with the MAAS, KIMS,
CAMS-R, and SMQ (r’s = 0.31 to 0.60) [44]. As expected, the FMI was positively
correlated with openness, self-compassion, and self-knowledge, and negatively correlated
with psychological symptoms, neuroticism, difficulties in emotion regulation, alexithymia,
dissociation, and distress [44,54]. However, there was an unexpected positive relationship
between FMI scores and smoking/frequent binge-drinking among undergraduate college
students, suggesting that the FMI may not be valid when completed by persons without
some familiarity or experience with insight meditation [55]. This review pooled the findings
from the original German version of the FMI [53,54] with those of its English translation

[44,55] because of the importance of the FMI as the first insight meditation-inspired selfreport
measure of mindfulness published.

Cognitive and Affective Mindfulness Scale-Revised (CAMS-R)

The CAMS-R was designed to measure mindfulness in a brief, jargon-free, and conceptually
comprehensive way, with the intention that it would be a generic measure appropriate
regardless of meditation experience. Based on Kabat-Zinn’s definition [56], “awareness that
emerges through paying attention on purpose, in the present moment, and non-judgmentally
to the unfolding of experience moment to moment,” the authors conceptualized mindfulness
as having four aspects: attention, present-focus, awareness, and acceptance/non-judgment
[57]. Factor analyses provided moderate evidence of the predicted four aspects reflecting an
overarching construct of mindfulness [57]. There was evidence of the internal consistency of
the CAMS-R (Cronbach alphas ranging from 0.61 to 0.81). The CAMS-R had moderate
correlations with other measures of mindfulness, including MAAS, FMI, KIMS, and SMQ
(r’s = 0.51 to 0.67) [44,57]. Construct validity was supported by positive relationships with
measures of adaptive regulation, openness, and well-being, and negative relationships with
neuroticism, difficulties in emotion regulation, dissociation, and stagnant deliberation [44].
The CAMS-R, and not the original CAMS, was included in this review, because the
developers determined that the CAMS was seriously flawed, and do not support its use [57].

Southampton Mindfulness Questionnaire (SMQ)

The SMQ was designed to assess awareness of distressing thoughts and images defined as a
concept consisting of four related constructs: awareness of cognitions as mental events in
wider context, allowing attention to remain with difficult conditions, accepting such difficult
thoughts and oneself without judging, and letting difficult cognitions pass without reactions
such as rumination [58]. Although factor analysis suggested a single factor structure for the
SMQ, a single-factor solution explained less than 50% of the variance [58]. There was
evidence of the internal consistency of the SMQ (Cronbach alphas ranging from 0.82 to
0.89). Correlations between the SMQ and other measures of mindfulness varied from weak
to moderate (r’s = 0.38 to 0.61) [44,58]. Consistent with expectations, the SMQ correlated
positively with emotional intelligence and self-compassion, and negatively with neuroticism,
difficulties in emotion regulation, alexithymia, dissociation, and negative affect [44,58].
SMQ scores were higher in meditators compared to non-meditators, and in non-clinical
samples compared to patients with psychosis [58].

Five Facet Mindfulness Questionnaire (FFMQ)

The FFMQ was derived from factor analysis of the combined item pool from five
independently developed mindfulness instruments: MAAS, KIMS, FMI, CAMS-R, and
SMQ [44]. The FFMQ has four facets similar to those of the KIMS (Observing, Describing,
Acting with Awareness, and Nonjudging of inner experience) and one more facet comprised
of items from the FMI and SMQ (Nonreactivity to inner experience). The authors found that
the relationship between the facets and an overarching construct of mindfulness differed
based on meditation experience, and that associations with symptoms and other constructs
differed by facet. Therefore, they suggested use of the individual subscales may be preferred
to use of the total FFMQ score. A 5-factor structure for the FFMQ was suggested by EFA
[44] and confirmed by good or acceptable fit indexes in CFA using the same parceling
approach for CFA employed in developing the KIMS [50,59]. A recent, standard item-level
CFA supported the original 5-factor structure and an over-arching mindfulness factor [60].
Others have shown a modest fit for this structure [61], and hierarchical models that
supported only four factors (all but Observe) as facets of an overarching mindfulness
construct in student samples [44]. Internal consistency of the FFMQ is adequate with
Cronbach alphas for the five subscales ranging from 0.67 to 0.93. Construct validity for the global FFMQ and its subscales has been evidenced by positive correlations with openness,
emotional intelligence, self-compassion, and well-being, and negative correlations with
neuroticism, depression, anxiety, alexithymia, and dissociation [44,62-66]. Meditators
scored higher on the FFMQ than non-meditating students, and meditation history was
correlated with a total FFMQ score in meditating samples (r = 0.52) [67]. The FFMQ
Observe and Describe subscales were derived largely from the KIMS, and as with the
KIMS, relationships with these subscales were less robust and predictable than those with
other facets. For example, significant differences in Observe and Describe were not found
between high- and low-worry groups [66]. There was little or no evidence for differential
item functioning (DIF) between meditators and non-meditators matched for age [68],
although the developers previously found that the structure of the FFMQ, particularly with
respect to the Observe facet, differed between meditators and non-meditators [44].

Toronto Mindfulness Scale (TMS)

The TMS was designed to assess mindfulness as a “quality maintained when attention is
intentionally cultivated with an open, non-judgmental orientation to experience” [69]. The
original TMS measures mindfulness as a state-like quality, and not as a trait. The
administration of the TMS requires that a brief mindfulness exercise precede selfadministration
of the instrument, and the TMS items assess the quality of that experience.
The TMS is composed of two subscales, Curiosity and Decentering, and a total TMS score
is not reported. EFA suggested a 2-factor structure for the TMS, and this was supported by
CFA [69]. The TMS had evidence of internal consistency with Cronbach alphas ranging
from 0.86 to 0.91, and 0.85 to 0.87 for Curiosity and Decentering, respectively. Correlations
for the Decentering subscale with most of the other measures of mindfulness, including
MAAS, FMI, CAMS-R, SMQ, KIMS subscales, and FFMQ subscales (r’s = 0.20 to 0.74)
were stronger than the correlations between the Curiosity subscale and these measures (r’s =
0.10 to 0.54) [70]. Curiosity and Decentering were positively correlated with absorption,
awareness of surroundings, reflective self-awareness, and psychological mindedness. As
hypothesized, only Curiosity was correlated with awareness of internal states and selfconsciousness
(r = 0.41 and 0.31), and only Decentering was correlated with openness and
cognitive failures (r = 0.23 and -0.16) [69]. Curiosity and Decentering scores were higher in
meditators than non-meditators, and scores for the Decentering subscale were shown to
increase with meditation experience [70]. Changes in Decentering were associated with
changes in symptoms and stress [69].

Experiences Questionnaire (EQ)

The EQ was designed to measure decentering, a construct described as the ability to adopt a
wider perspective where one’s thoughts are viewed as separate from oneself, and not
necessarily an objective reflection of reality [71]. Decentering is posited to be a major
outcome of mindfulness-based cognitive therapy and a mechanism that enables patients to
be resilient to depressive thoughts. The authors did not view decentering as synonymous
with mindfulness, but closely related or a component of mindfulness. The EQ was originally
designed to have items reflecting decentering and rumination; however, the structure was
determined to be unifactorial for the construct of decentering [71]. The EQ had evidence of
internal consistency (Cronbach alphas ranging from 0.83 to 0.90), and construct validity was
supported by positive correlations with cognitive appraisal (r = 0.25), and negative
correlations with experiential avoidance, brooding rumination, emotional suppression,
current depression, and anxiety symptoms (|r|’s = 0.31 to 0.49) [71]. Patients with
depression had lower levels of decentering compared to healthy controls [71].

Mindfulness/Mindlessness Scale (MMS)

The MMS was designed to assess mindfulness from a cognitive-information processing
framework as active awareness of and engagement with the environment [72]. Its Western
cognitive derivation distinguishes the MMS from the other measures presented in this
review. The MMS is composed of four subscales: Novelty Seeking, Engagement, Novelty
Producing, and Flexibility. The 4-factor structure has not been supported, and a 2-factor
structure explaining 34% of the variance has been reported [72]. Evidence of internal
consistency was positive for the MMS as a single scale with Cronbach alphas ranging from
0.81 to 0.86. Cronbach alphas for the MMS subscales ranged from 0.45 to 0.77. There was
mixed evidence regarding the relationships between MMS items and measures of mood.

Philadelphia Mindfulness Scale (PHLMS)

The PHLMS was designed to assess mindfulness defined as “the tendency to be highly
aware of one’s internal and external experiences in the context of an accepting,
nonjudgmental stance toward those experiences” [73]. This definition was operationalized as
two constructs: Awareness – a behavioral tendency of continuously monitoring current
experience, and Acceptance – a stance of experiencing events, including cognitions, without
judgments and reactions such as interpretation, elaboration or avoidance. The subscales were
shown to be uncorrelated, and use of a total PHLMS score is not recommended. A 2-factor
structure for the PHLMS was supported by CFA [73]. Internal consistency was also
supported with Cronbach alphas ranging from 0.75 to 0.86, and 0.75 to 0.91 for Awareness
and Acceptance, respectively. Evidence of construct validity was mixed [73]. For example,
the Awareness subscale was strongly correlated with the KIMS Observe subscale (r = 0.83)
and the Acceptance subscale was strongly correlated with the KIMS Accept without
Judgment subscale (r = 0.79) [73]. However, the correlation between the Awareness
subscale and MAAS was weak (r = 0.21) for student samples and moderate (r = 0.40) for
psychiatry outpatients. The correlation between the Acceptance subscale and MAAS was
also weak (r = 0.32) for the normative student samples. As expected, student samples scored
higher on both PHLMS subscales than psychiatry outpatients, and students scored higher on
the Acceptance subscale compared to the inpatients with eating disorders (EDs). However,
Awareness scores were not significantly different between students and inpatients with EDs.

Pour les praticiens

Pour les praticiens qui ne s’occupent pas de recherche, ces échelles ne sont pas nécessaires.

Personnellement, sans avoir besoin d’échelles, le niveau de pleine conscience de la personne me semble évident, en particulier les comportements facilement observables liés au non-jugement, à la non-réactivité, à l’acceptation, à la décentration, à la conscience, à la description, à la curiosité et à la focalisation sur le présent. Cette hétéro-évaluation me semble parfois plus fiable que des auto-évaluations en particulier concernant des méditants débutants. Toutefois cela requiert une certaine expertise de la part de l’évaluateur et c’est aussi plus difficile à utiliser dans le cadre de recherches quantitatives.

J’aime beaucoup la façon de comprendre les processus de pleine conscience utilisés dans l’ACT, la thérapie d’acceptation et d’engagement, à savoir le contact avec la réalité présente, la défusion cognitive, l’accueil ou l’acceptation de ce qui est, le sentiment de soi non-conceptuel à partir duquel nous sommes conscients de l’expérience. Ces quatre processus font d’ailleurs l’objet d’échelles de mesure propres à l’ACT (Acceptance and Commitment Therapy).