ReviewMindfulness-based stress reduction for healthy individuals: A meta-analysis
Introduction
Stress is prevalent in modern society and has become a significant global health problem [1], [2]. Research suggests that high levels of stress can negatively affect both physical and mental health and are found to be associated with autoimmune diseases [3], migraines [4], obesity [5], muscle tension and backache [6], high cholesterol [7], coronary heart disease [8], hypertension [9], and stroke [10].
In the last decade, interest in research investigating mindfulness-based interventions has increased substantially [11]. Even though a consensus about an unequivocal operational definition of mindfulness is lacking so far [12], [13], one of most commonly employed definitions of mindfulness was provided by Jon Kabat-Zinn who suggests that mindfulness could be described as a moment to moment awareness that is cultivated by purposefully paying attention to the present experience, with a non-judgmental attitude [14]. Interventions utilizing mindfulness techniques have shown efficacy for treating a variety of mental disorders and in coping with physical or medical conditions, including, among others, chronic pain [15], fatigue [16], stress [17], [18], cancer [19], heart disease [20], type 2 diabetes [21], psoriasis [22], and insomnia [23].
Mindfulness-based stress reduction (MBSR) [24] is a well-established mindfulness training that has shown to reduce stress, depression, and anxiety [25], [26]. MBSR teaches individuals to observe situations and thoughts in a nonjudgmental, nonreactive, and accepting manner. MBSR provides training in formal mindfulness practices, including body scan, sitting meditation, and yoga. MBSR seeks to change the individual's relationship with stressful thoughts and events by decreasing emotional reactivity and enhancing cognitive appraisal [27]. The standard MBSR curriculum is conducted in an 8-week structured group format, which includes weekly 2.5-hour group sessions in addition to a 6-hour daylong retreat.
Although initially developed for chronic pain, MBSR has reported positive results among an array of clinical and nonclinical populations, including cancer, health care professionals, continuing education students, and college undergraduates [28], [29], [30]. Chiesa et al. [28] were the first to systematically investigate the usefulness of MBSR in healthy individuals. They concluded that MBSR provided a significant nonspecific moderate to large effect on the reduction of stress in comparison with no-treatment controls. However, there were significant methodological limitations and only 10 studies were included in the analysis. Eberth and Sedlmeier [30] conducted a meta-analysis of 38 controlled studies on the effects of mindfulness meditation on psychological well-being among a nonclinical population. Among the 38 studies, 17 used MBSR, the results suggested moderate effects in reducing stress and negative emotions and in increasing well-being. However, the meta-analysis included only studies that were published before March 2010, had some methodological limitations (e.g., it did not implement PRISMA criteria and it did not include a quality measure), failed to determine moderators of the observed effects, did not investigate the role of mindfulness in the effectiveness of the interventions, and did not investigate long-term effects of MBSR.
A more recent qualitative systematic review examined the effects of MBSR on stress management in nonclinical populations in 17 trials dating between January 2009 and 2014 [29]. The outcomes suggested positive effects on both psychological and physiological measures without quantifying these effects. Overall, the current state of the literature suggests the need for a more systematic quantifiable summarization of the effects, mechanisms of actions, and moderators of MBSR for nonclinical populations. Therefore, we conducted a comprehensive effect-size analysis with the following objectives: (1) to quantify the effect size of MBSR for psychological variables (i.e., anxiety, depression, stress, distress, and burnout) in healthy individuals; (2) to investigate and quantify the role of mindfulness in MBSR; and (3) to explore moderator variables.
Section snippets
Power analysis
Assuming an average sample size of 25 individuals per group (on the basis of previous meta-analyses, e.g., 31), a small to moderate effect size of 0.3 (on the basis of previous meta-analyses comparing mindfulness to other active treatments, e.g., psycho-education; 31), and a large heterogeneity among the studies (as MBSR studies differ from each other in their design, implementation, and included outcomes), for a power of 80%, 15 studies comparing MBSR to an active treatment will be needed. For
Study selection
Medline produced 400 articles, CINAHL yielded 236 publications, and Alt HealthWatch produced 40 articles. We carefully assessed the identified publications and applied the exclusion criteria, resulting in 30 publications, from which one was excluded due to insufficient data to compute the effect size. The study selection process is illustrated in detail in Fig. 1.
Study characteristics
The effect size (Hedge's g) and other characteristics for each study are shown in Table 1. The total number of participants was 2668
Discussion
This meta-analysis examined 29 studies using MBSR for a total of 2668 healthy participants. The results showed that MBSR is moderately effective in both within group and between group analyses. Only one study compared MBSR to an active treatment, the effect size was small but it cannot be generalized.
Even though the MBSR interventions in the studies included in this meta-analysis did not target a clinical population, moderate effects were found on multiple clinical measures including,
Conflict of interest statement
All authors of this article had access to all study data, are responsible for all contents of the article, and had authority over manuscript preparation and the decision to submit the manuscript for publication. Authors of this article have approved the submission of the manuscript to the journal and have no competing interests. The data presented in the article is novel and has not yet been presented elsewhere.
Acknowledgment
No official funding was provided to conduct the current meta-analysis. All authors have actively participated in preparing this manuscript. The authors have no competing interests to report. The first author (B.K.) led the meta-analysis in all its stages and worked on the data collection, analyses, and report writing, he has full access to all of the data in the meta-analysis and he takes full responsibility for the integrity of the data and the accuracy of the reported analyses. The second
References (72)
- et al.
Is emotional stress an etiologic factor in coronary heart disease?
Psychosomatics
(1976) - et al.
Mindfulness-based stress reduction and health benefits: a meta-analysis
J Psychosom Res
(2004) - et al.
How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help?
Behav Res Ther
(1995) - et al.
Mindfulness-based therapy: a comprehensive meta-analysis
Clin Psychol Rev
(2013) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
Mindfulness interventions for psychosis: a meta-analysis
Schizophr Res
(2013) - et al.
The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine clinical practice
Behav Res Ther
(2005) - et al.
Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: a meta-analysis
Int J Nurs Stud
(2012) - et al.
The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis
Clin Psychol Rev
(2011) - et al.
Mindfulness-based stress reduction (MBSR) in perceived stress and quality of life: an open, uncontrolled study in a Brazilian healthy sample. EXPLORE
J Sci Heal
(2014)
European agency for safety and health at work
OSH in figures: stress at work-facts and figures
Practical stress management
A comprehensive workbook
The healing brain: a new perspective on the brain and health
Migraine headache
Am Fam Physician
Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome
Nat Med
Relations between occupational, psychosocial and individual factors and three different categories of back disorder among supermarket workers
Int Arch Occup Environ Health
Changes in the serum cholesterol and blood clotting time in men subjected to cyclic variation of occupational stress
Circulation
The amazing way to reverse heart disease: beyond the hypertension hype: why drugs are not the answer
Current perspectives on hypertension and metabolic syndrome
J Manag Care Pharm
A systematic review of neurobiological and clinical features of mindfulness meditations
Psychol Med
The difficulty of defining mindfulness: current thought and critical issues
Mindfulness
Classical mindfulness: an introduction to its theory and practice for clinical application
Ann N Y Acad Sci
Wherever you go, there you are: mindfulness meditation in everyday life
Four-year follow-up of a meditation-based program for the self-regulation of chronic pain: treatment outcomes and compliance
Clin J Pain
The effect of mindfulness training on mood and measures of fatigue, activity, and quality of life in patients with chronic fatigue syndrome on a hospital waiting list: a series of exploratory studies
Behav Cogn Psychother
Stress reduction through mindfulness meditation. Effects on psychological symptomatology, sense of control, and spiritual experiences
Psychother Psychosom
The effects of a mindfulness-based stress reduction program on stress, mindfulness self-efficacy, and positive states of mind
Stress Health
Mindfulness-based stress reduction as supportive therapy in cancer care: systematic review
J Adv Nurs
Mindfulness meditation, anxiety reduction, and heart disease: a pilot study
Fam Community Health
Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study
Altern Ther Health Med
Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA)
Psychosom Med
Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders: a pilot study
J Nerv Ment Dis
Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness: fifteenth anniversary edition
The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review
J Consult Clin Psychol
Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis
J Altern Complement Med
Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review
J Evid Based Complement Alternat Med
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