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The Evidence

Mindfulness-based interventions have gained considerable popularity in practice and in research, which has grown exponentially since the 1980s. Numerous studies and accounts have documented its social, health and workplace benefits with both clinical and non-clinical populations. Moreover, research has also demonstrated that client outcomes are improved when psychotherapists/clinicians practice mindfulness.[1]

The benefits of mindfulness that have been identified are [2]:

  • Stress reduction
  • Reduced rumination
  • Decreased negative affect (e.g. depression, anxiety)
  • Less emotional reactivity/more effective emotion regulation
  • Increased focus
  • More cognitive flexibility
  • Improved working memory

Currently there are a number of different forms of mindfulness-based interventions used in the field but they are largely variants of the two basic training programs, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT).

Below are some details of the evidence as it pertains to various programs and health conditions, including references to studies.

[1] Grepmair et al, 2007. Psychotherapy and Psychosomatics, vol. 76. No 6.

[2] Davis, D, and Hayes, JA, 2012. What are the Benefits of Mindfulness. American Psychological Association, Monitor on Psychology. July/August 2012 (http://www.apa.org/monitor/2012/07-08/ce-corner.aspx)

MBSR & MBCT

MBSR (Mindfulness-Based Stress Reduction) was developed by Jon Kabat-Zinn at the University of Massachusetts Medical School [3] and was originally used with a range of people who were experiencing chronic pain and stress. It is a union of medicine, psychology and meditative traditions like Buddhism but is completely secular in its approach. In MBSR, participants learn to recognize habitual, unhelpful reactions to difficulty and learn instead to bring an interested, accepting and non-judgmental attitude to all experience, including difficult sensations, emotions, thoughts and behavior.

MBCT (Mindfulness-Based Cognitive Therapy) was developed by Zindel Segal, Mark Williams and John Teasdale. It has proven effective for preventing serious recurrent depression (depression relapse), for which it was developed. In addition, it has also been shown to be useful for acute depression and anxiety dependent up the severity of the condition. MBCT replaces some of the content of MBSR and incorporates elements of cognitive behaviour therapy. The key difference is that instead of MBSR’s focus on stress, in MBCT the focus is on turning toward low mood and negative thoughts so that participants gain experience with recognizing these symptoms as precursors to depressive relapse. The focus is on changing one’s relationship to these unwanted thoughts, feelings and body sensations so that participants no longer try to avoid them or react to them automatically, but rather respond to them in an intentional and skillful manner. Both MBSR and MBCT have now been adapted for different kinds of psychological/mental health and physical/medical conditions.

Evidence of the Effectiveness of MBSR and MBCT

The research literature on the effectiveness of Mindfulness-Based Therapies (MBTs) such as MBSR and MBCT has grown exponentially since the 1980s. Past research include a number of methodological problems that limited the validity of results: small sample sizes, lack of long term follow-up, no control comparison groups, heavily dependent on self-report outcomes, and variation in teaching of mindfulness. However, the quality of the research has improved considerably in recent years, using the gold standard of research design – the randomized control study comparing the outcomes of participants in the mindfulness intervention group with those who are in an “active control” group, i.e. the mindfulness group and the control group are the same except for the aspects of the intervention being tested.

Meta-analysis is a statistical technique for combining the findings from many independent studies and is most often used to assess the clinical effectiveness of healthcare interventions.

Overall, a review of meta-analyses found evidence that supports the use of MBSR and MBCT in alleviating both mental and physical symptoms, as an adjunct treatment of cancer, cardiovascular disease, chronic pain, depression, anxiety disorders and in prevention in healthy adults and children. [4]

In the below boxes are the findings from individual meta-analyses, as well as individual randomized control trials, of the effectiveness of MBSR, MBCT and other mindfulness-based interventions in treating these various health conditions.

[3] Centre for Mindfulness in Medicine, Health Care and Society. http://www.umassmed.edu/cfm/

[4] Gotink et al., 2015. Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS One. 2015 Apr 16;10(4):e0124344. http://dx.doi.org/10.1371/journal.pone.0124344. eCollection 2015

Stress, Anxiety & Depression

MBTs are as effective in treating a variety of psychological problems including anxiety, depression, and stress in comparison with other psychological or pharmacological treatments. These benefits have been shown to be maintained at follow-up[3] [4] Meditation programs in general and mindfulness programs in particular have been shown to reduce the multiple negative dimensions of psychological stress. [5] [6] One study showed that MBSR is as effective as cognitive behaviour therapy for generalized social anxiety disorder, although their effects may be a result of both shared and unique changes in underlying psychological processes.[7]

MBTs are effective treatments for anxiety and depression in cancer patients and survivors. MBT also significantly improved mindfulness skills. [8]

MBSR has been shown to have positive effects on the mental health of breast cancer patients.[9] [10]

Depression Relapse

MBCT has been shown to be an effective intervention for preventing relapse in depressed patients, especially in patients who have had 3 or more previous major depressive disorder episodes and those with more severe symptoms. MBCT was shown to be as effective as maintenance anti-depressants in preventing relapse. The significance of the latter finding is that depressed patients are presented with a treatment choice other than drugs. It has also been suggested that MBT can be used in conjunction with other treatments and in other settings. [11] [12] [13] [14] [15]

These studies focused on preventing depression in people who were currently well. It was hypothesized that MBTs may not be effective for people who were currently experiencing symptoms. However, one meta-analysis found that MBCT provided significant benefits to people who were experiencing a current depressive episode. Benefits of MBCT have been shown to be similar to those of group CBT.[16]

As to how mindfulness works to prevent depression relapse, one meta-analysis found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT’s effect on treatment outcome. Preliminary studies also indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.[17]

 

[3] Khoury B et al, 2013. Mindfulness-based therapy: A comprehensive meta-analysis. Clin Psychol Rev.  Aug;33(6):763-71. doi: 10.1016/j.cpr.2013.05.005. Epub 2013 Jun 7. http://www.ncbi.nlm.nih.gov/pubmed/23796855

[4] Hoffman S, Sawyer A, Witt A, Oh D, 2010. The effect of Mindfulness-based therapy on anxiety and depression: a meta-analytic review. Journal of Consulting and Clinical Psychology, Vol 78(2), pp 169-183.

[5] Goyal et al, 2014. Meditation Programs for Psychological Stress and Well-Being. Comparative Effectiveness Reviews, No. 124

[6] Sharma, M, Rush S, 2014. Mindfulness-Based Stress Reduction as a Stress Management Intervention for Healthy Individuals: A Systematic Review. Journal of Evidence-Based Complementary & Alternative Medicine , 19:4, 271-286

[7] Goldin, P, et al., 2016. Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial. J Consult Clin Psychol. 84(5):427-437. Epub 2016 Mar 7.

[8] Piet, J, Wurtzen, H and Zachariae, R, 2012. The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, Vol 80(6), Dec 2012, 1007-1020. http://dx.doi.org/10.1037/a0028329

[9] Zainal N, Booth S a& Huppert F, 2013. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psycho-Oncology, Volume 22, Issue 7, pages 1457–1465, July 2013

[10] H. Cramer, R. Lauche, A. Paul, G. Dobos, 2012. Mindfulness-based stress reduction for breast cancer— a systematic review and meta-analysis. Current Oncology, Vol 19, No. 5, 2012

[11] P Klainin-Yobas , Ma Aye A, Cho, D, 2012. Efficacy of mindfulness-based interventions on depressive symptoms among people with mental disorders: A meta-analysis. International Journal of Nursing Studies, Volume 49, Issue 1, 109–121.

[12] Kuyken et al, 2015. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial. The Lancet, Volume 386, No. 9988, p63–73, 4 July 2015. http://dx.doi.org/10.1016/S0140-6736(14)62222-4

[13] Piet J & Hougaard E, 2011. 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.  Aug;31(6):1032-40. doi: 10.1016/j.cpr.2011.05.002. Epub 2011 May 15

[14] Segal Z. V., Williams J. M. G., & Teasdale J. D., 2002. Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.

[15] Williams J. M. G., Teasdale J. D., Segal Z. V., & Kabat-Zinn J., 2007. The mindful way through depression: Freeing yourself from chronic unhappiness. New York: Guilford.

[16] Strauss C et al., 2014.Mindfulness-Based Interventions for People Diagnosed with a Current Episode of an Anxiety or Depressive Disorder: A Meta-Analysis of Randomised Controlled Trials. Article in PLoS ONE 9(4):e96110 · April 2014 Impact Factor: 3.23 http://dx.doi.org/10.1371/journal.pone.0096110 · Source: PubMed

[17] Van der Velden AM et al., 2015. A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clin Psychol Rev. Apr;37:26-39. doi: 10.1016/j.cpr.2015.02.001. Epub 2015 Feb 11

Youth

The first published meta-analysis of research on mindfulness meditation with youth (conducted between 2004 and 2011) found that mindfulness was a promising intervention. The results indicated the superiority of mindfulness treatments over active control comparison conditions, particularly for youth with clinical symptoms. Although to date the majority of studies on mindfulness with youth engage generally healthy participants recruited from schools, the findings of this meta-analysis suggest that future research might focus on youth in clinical settings and target symptoms of psychopathology.[1]

An 8-week mindfulness program was found to be effective for youth with ADHD aged 11-15. After mindfulness training, adolescents’ attention and behavior problems reduced, their executive functioning improved, as indicated by self-report measures as well as by father and teacher report. Improvements in actual performance on attention tests were also found. Effects of mindfulness training became stronger at 8-week follow-up, but waned at 16-week follow-up. The study suggests that mindfulness training for adolescents with ADHD (and their parents) is an effective approach, but maintenance strategies need to be further developed.[2]

One randomized trial showed that an MBCT program for children was a promising intervention for attention and behaviour problems, and may reduce childhood anxiety.[3]

[1] Zoogman et al., 2015. Mindfulness Interventions with Youth: A Meta-Analysis. Mindfulness, April Volume 6, Issue 2, pp 290-302

[2] Van de Weijer-Bergsma et. al., 2012. The Effectiveness of Mindfulness Training on Behavioral Problems and Attentional Functioning in Adolescents with ADHD. J Child Fam Stud 21:775–787  http://dx.doi.org/10.1007/s10826-011-9531-7

[3] Semple R et al., 2010. A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children. Journal of Child and Family Studies, 19:2, 218-229

Diabetes

Emotional distress is a common co-morbid condition of diabetes. Approximately 20 to 40% of people with type 1 or type 2 diabetes are affected by emotional distress, which can consist of symptoms of depression, anxiety, and diabetes-specific distress.[1] Emotional distress has been shown to result in a lower quality of life as well as a more negative appraisals of insulin therapy. In addition, depression is associated with suboptimal self-care behaviors,[2] suboptimal glycemic control,[3] adverse cardiovascular outcomes, and higher mortality rates.[4] Although the emotional problems in diabetic patients have received increasing attention in the last decade, they are still often not recognized in clinical practice and remain untreated.

One randomized control trial has shown that MBCT is more effective than treatment as usual in reducing stress, depressive symptoms, and anxiety, and in improving quality of life, both mental and physical.[5] However, the authors found no significant effect on HbA1c (glycated haemoglobin) or diabetes-specific distress. Nevertheless patients with elevated diabetes distress in the MBCT group did show a decrease in diabetes distress (P = 0.07, d = 0.70) compared with the control group.

[1] Grigsby et al., 2002.Prevalence of anxiety in adults with diabetes: a systematic review. J Psychosom Res; 53:10531060. pmid:12479986

[2] Gonzalez JS, et al. 2008. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31:2398–2403, pmid:19033420OpenUrl

[3] Lustman PJ et al. 2000. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care. 23:934–942pmid:10895843

[4] Bogner HR et al. 2007. Diabetes, depression, and death: a randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT). Diabetes Care. 30:3005–3010pmid:17717284

[5] Jenny van Son, et al., 2013.The Effects of a Mindfulness-Based Intervention on Emotional Distress, Quality of Life, and HbA1c in Outpatients With Diabetes (DiaMind). Diabetes Care. Apr; 36(4): 823-830. http://dx.doi.org/10.2337/dc12-1477

Compassion

Research has shown that compassion is an important variable in explaining mental health and resilience.[1] Two components of mindfulness — nonjudging and nonreacting — were strongly correlated with self-compassion, as were two dimensions of empathy — taking on others’ perspectives (i.e., perspective taking) and reacting to others’ affective experiences with discomfort.[2] A recent systematic review of the literature found that changes in mindfulness and compassion combined correlated with changes in stress, moderate effects on anxiety, depression, distress, and quality of life.[3]

[1] MacBeth A, A Gumley, 2012. Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychological Review. 32: 545- 552.

[2] Shapiro, S, K Brown, G Biegel. Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training.Training and Education in Professional Psychology, Vol 1(2), May 2007, 105-115. http://dx.doi.org/10.1037/1931-3918.1.2.105

[3] Khoury, B et al., 2015. Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research. 78(6): 519–528

Neuroscience

Scientists continue to research the question as to how mindfulness affects the brain. Recent neuroimaging studies have begun to uncover the brain areas and networks that mediate the positive effects of mindfulness meditation in the reduction of stress and the promotion of health.[1] [2] [3] One study found 8 brain regions that consistently altered in meditators, including areas key to meta-awareness (prefrontal cortex), exteroceptive and interoceptive body awareness (sensory cortices and insula), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication (superior longitudinal fasciculus; corpus callosum). [4] Nevertheless, the underlying neural mechanisms are still unclear and more research is needed to understand the changes in the brain that are associated with mindfulness.[5] However, scientists are researching the specific pathways on how mindfulness affects specific emotional states such as emotional regulation.[6]

[1] Farb NAS, Segal ZV, Anderson AK (2013). Mindfulness meditation training alters cortical representations of interoceptive attentionSocial, Cognitive and Affective Neuroscience, 8(1), 15-26. (Supplementary Materials)

[2] Farb NAS, Segal ZV, Anderson AK (2013). Attentional Modulation of Primary Interoceptive and Exteroceptive Cortices. Cerebral Cortex, 23(1), 114-26.

[3] Farb NAS, Segal ZV, Mayberg H, Bean J, McKeon D, Fatima Z, Anderson AK (2007). Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience, 2(4), 313-122. (PDF)

[4] Fox K et al., 2014. Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners. Neurosci Biobehav Rev. Jun;43:48-73. http://dx.doi.org/10.1016/j.neubiorev.2014.03.016. Epub 2014 Apr 3.

[5] Yi-Yuan Tang, B Holzel, M Posner, 2015. The neuroscience of mindfulness meditation. Nature Reviews Neuroscience. 16, 213-225

[6] Gerucci, Pappaianni, Siugzdaite, Theuninck, & Job, 2015. Mindful Emotion Regulation: Exploring the Neurocognitive Mechanisms behind Mindfulness. BioMed Research International, Volume 2015 (2015), Article ID 670724, 9 pages. http://dx.doi.org/10.1155/2015/670724

Addiction

Addiction has generally been characterized as a chronic relapsing condition. Studies have provided evidence that craving and negative affect are strong predictors of the relapse process. A recently developed behavioral treatment, Mindfulness-Based Relapse Prevention (MBRP), designed to target experiences of craving and negative affect integrates cognitive behavioral relapse prevention with mindfulness meditation. In a recent RCT those treated with MBRP demonstrated significantly lower rates of substance use and greater decreases in craving following treatment. Areas of the brain that have been associated with craving, negative affect, and relapse have also been shown to be affected by mindfulness training.[1]

[1] Witkiewitz K, Lustyk M, & Bowen S, 2012/ Re-Training the Addicted Brain: A review of hypothsized neurobiolgical meechanisms ofmindfulness-based relapse prevention. Psychol Addict Behav. 27(2) p 351-365. Published online 2012 Jul 9. http://dx.doi.org/10.1037/a0029258

Pain

Chronic pain is a major health condition that has both financial and lifestyle implications. Pain can have a number of causes and therefore it is difficult to find a common set of treatments that are universally applicable. Although changing or controlling pain is not an explicit aim of MBTs, recent studies show that mindfulness may lead to changes in pain tolerance and pain intensity ratings.[1] [2]

MBSR may also be an effective treatment option for adults with chronic low back pain. MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. [3]

Neuroimaging evidence reveals that mindfulness meditation-related pain relief is associated with unique appraisal cognitive processes (personal interpretation of a situation) depending on expertise level and meditation tradition. Mindfulness meditation-related pain relief may share a common final pathway with other cognitive techniques in the modulation of pain.[4]

[1] Reiner K, Tibi L, Lipsitz J, 2013. Do mindfulness-based interventions reduce pain intensity? A critical review of the literature. Pain Med. Feb;14(2):230-42. doi: 10.1111/pme.12006. Epub 2012 Dec 13.

[2] Parth Rajguru et at., 2014. Use of Mindfulness Meditation in the Management of Chronic Pain: A Systematic Review of Randomized Controlled Trials. American Journal of Lifestyle Medicine February 21.

[3] Cherkin D et al, 2016. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain:  A Randomized Clinical Trial. JAMA. 2016;315(12):1240-1249.  http://dx.doi.org/10.1001/jama.2016.2323

[4] Zeidan F et al., 2012. Mindfulness meditation-related pain relief: Evidence for unique brain mechanisms in the regulation of pain. Neurosci Lett. 2012 Jun 29; 520(2): 165–173. Published online 2012 Apr 6. http://dx.doi.org/10.1016/j.neulet.2012.03.082

Cardiovascular Disease

Studies have looked at the effectiveness of MBSR and MBCT on psychological and physical outcomes for people with vascular disease. While there is evidence of significant reductions in stress, depression and anxiety, the effects on physical outcomes, such as blood pressure, albuminuria and stress hormones, were mixed.[1]

Following transient ischemic attack/stroke, evidence points to the benefits of MBT across a range of psychological, physiological and psychosocial outcomes, which include anxiety, depression, mental fatigue, blood pressure, perceived health and quality of life. However, better research is needed.[2]

[1] Abbott, R et al., 2014. Effectiveness of mindfulness-based stress reduction and mindfulness based cognitive therapy in vascular disease: A systematic review and meta-analysis of randomised controlled trials. Journal of Psychosomatic Research.Vol76 (5), p 341-351

[2] Lawrence M et al, 2013. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. Aug; 8(6):465-74. doi: http://dx.doi.org/10.1111/ijs.12135

Eating Disorders

One review study found initial evidence supporting the effectiveness of mindfulness-based interventions to the treatment of eating disorders and indicates that using mindfulness-based interventions is a promising approach for the treatment of eating disorders and for further research.[1]

[1] Wanden-Berghe R et al., 2011. The application of mindfulness to eating disorders treatment: a systematic review. Eating Disorders, 19(1):34-48. http://dx.doi.org/10.1080/10640266.2011.533604

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