Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis | Complementary and Alternative Medicine | JAMA Internal Medicine | JAMA Network
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1.
Barnes  PM, Bloom  B, Nahin  RL.  Complementary and alternative medicine use among adults and children: United States, 2007.  Natl Health Stat Report. December 10, 2008;(12):1-23.Google Scholar
2.
Goyal  M, Haythornthwaite  J, Levine  D,  et al.  Intensive meditation for refractory pain and symptoms.  J Altern Complement Med. 2010;16(6):627-631.PubMedGoogle ScholarCrossref
3.
Rapgay  L, Bystrisky  A.  Classical mindfulness: an introduction to its theory and practice for clinical application.  Ann N Y Acad Sci. August 2009;1172:148-162.PubMedGoogle ScholarCrossref
4.
Travis  F, Shear  J.  Focused attention, open monitoring and automatic self-transcending: categories to organize meditations from Vedic, Buddhist and Chinese traditions.  Conscious Cogn. 2010;19(4):1110-1118.PubMedGoogle ScholarCrossref
5.
Chiesa  A, Malinowski  P.  Mindfulness-based approaches: are they all the same?  J Clin Psychol. 2011;67(4):404-424.PubMedGoogle ScholarCrossref
6.
Sedlmeier  P, Eberth  J, Schwarz  M,  et al.  The psychological effects of meditation: a meta-analysis.  Psychol Bull. 2012;138(6):1139-1171.PubMedGoogle ScholarCrossref
7.
Bohlmeijer  E, Prenger  R, Taal  E, Cuijpers  P.  The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis.  J Psychosom Res. 2010;68(6):539-544.PubMedGoogle ScholarCrossref
8.
Chambers  R, Gullone  E, Allen  NB.  Mindful emotion regulation: an integrative review.  Clin Psychol Rev. 2009;29(6):560-572.PubMedGoogle ScholarCrossref
9.
Chiesa  A, Serretti  A.  Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis.  J Altern Complement Med. 2009;15(5):593-600.PubMedGoogle ScholarCrossref
10.
Chiesa  A, Calati  R, Serretti  A.  Does mindfulness training improve cognitive abilities? a systematic review of neuropsychological findings.  Clin Psychol Rev. 2011;31(3):449-464.PubMedGoogle ScholarCrossref
11.
Chiesa  A, Serretti  A.  Mindfulness based cognitive therapy for psychiatric disorders: a systematic review and meta-analysis.  Psychiatry Res. 2011;187(3):441-453.PubMedGoogle ScholarCrossref
12.
Hofmann  SG, Sawyer  AT, Witt  AA, Oh  D.  The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review.  J Consult Clin Psychol. 2010;78(2):169-183.PubMedGoogle ScholarCrossref
13.
Krisanaprakornkit  T, Ngamjarus  C, Witoonchart  C, Piyavhatkul  N.  Meditation therapies for attention-deficit/hyperactivity disorder (ADHD).  Cochrane Database Syst Rev. 2010;(6):CD006507.PubMedGoogle Scholar
14.
Ledesma  D, Kumano  H.  Mindfulness-based stress reduction and cancer: a meta-analysis.  Psychooncology. 2009;18(6):571-579.PubMedGoogle ScholarCrossref
15.
Matchim  Y, Armer  JM, Stewart  BR.  Mindfulness-based stress reduction among breast cancer survivors: a literature review and discussion.  Oncol Nurs Forum. 2011;38(2):E61-E71. doi:10.1188/11.ONF.E61-E71. PubMedGoogle ScholarCrossref
16.
Piet  J, Hougaard  E.  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;31(6):1032-1040.PubMedGoogle ScholarCrossref
17.
Wanden-Berghe  RG, Sanz-Valero  J, Wanden-Berghe  C.  The application of mindfulness to eating disorders treatment: a systematic review.  Eat Disord. 2011;19(1):34-48.PubMedGoogle ScholarCrossref
18.
Winbush  NY, Gross  CR, Kreitzer  MJ.  The effects of mindfulness-based stress reduction on sleep disturbance: a systematic review.  Explore (NY). 2007;3(6):585-591.PubMedGoogle ScholarCrossref
19.
Zgierska  A, Rabago  D, Chawla  N, Kushner  K, Koehler  R, Marlatt  A.  Mindfulness meditation for substance use disorders: a systematic review.  Subst Abus. 2009;30(4):266-294.PubMedGoogle ScholarCrossref
20.
Bernardy  K, Füber  N, Köllner  V, Häuser  W.  Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome: a systematic review and metaanalysis of randomized controlled trials.  J Rheumatol. 2010;37(10):1991-2005.PubMedGoogle ScholarCrossref
21.
Rainforth  MV, Schneider  RH, Nidich  SI, Gaylord-King  C, Salerno  JW, Anderson  JW.  Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis.  Curr Hypertens Rep. 2007;9(6):520-528.PubMedGoogle ScholarCrossref
22.
Anderson  JW, Liu  C, Kryscio  RJ.  Blood pressure response to transcendental meditation: a meta-analysis.  Am J Hypertens. 2008;21(3):310-316.PubMedGoogle ScholarCrossref
23.
Canter  PH, Ernst  E.  The cumulative effects of transcendental meditation on cognitive function: a systematic review of randomised controlled trials.  Wien Klin Wochenschr. 2003;115(21-22):758-766.PubMedGoogle ScholarCrossref
24.
So  KT, Orme-Johnson  DW.  Three randomized experiments on the longitudinal effects of the transcendental meditation technique on cognition.  Intelligence. 2001;29(5):419-440.Google ScholarCrossref
25.
Travis  F, Grosswald  S, Stixrud  W.  ADHD, brain functioning, and transcendental meditation practice.  Mind Brain J Psychiatr. 2011;2(1):73-81.Google Scholar
26.
Chen  KW, Berger  CC, Manheimer  E,  et al.  Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials.  Depress Anxiety. 2012;29(7):545-562.PubMedGoogle ScholarCrossref
27.
Chambless  DL, Hollon  SD.  Defining empirically supported therapies.  J Consult Clin Psychol. 1998;66(1):7-18.PubMedGoogle ScholarCrossref
28.
Hollon  SD, Ponniah  K.  A review of empirically supported psychological therapies for mood disorders in adults.  Depress Anxiety. 2010;27(10):891-932.PubMedGoogle ScholarCrossref
29.
Agency for Healthcare Research and Quality. Research protocol: mediation programs for stress and well-being. http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=981&pageaction=displayproduct. Accessed February 22, 2012.
30.
Effective Health Care Program. Methods Guide for Conducting Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research & Quality; August 2007. AHRQ Publication 10(11)-EHC063-EF.
31.
Higgins  JP, Altman  DG, Gøtzsche  PC,  et al; Cochrane Bias Methods Group; Cochrane Statistical Methods Group.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials.  BMJ. 2011;343:d5928. doi:10.1136/bmj.d5928.PubMedGoogle ScholarCrossref
32.
Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. London, England: Cochrane Collaboration; Updated March 2011. http://www.cochrane.org/training/cochrane-handbook. Accessed February 17, 2012.
33.
Owens  DK, Lohr  KN, Atkins  D,  et al.  AHRQ Series paper 5: grading the strength of a body of evidence when comparing medical interventions: Agency for Healthcare Research and Quality and the effective health-care program.  J Clin Epidemiol. 2010;63(5):513-523.PubMedGoogle ScholarCrossref
34.
Barrett  B, Hayney  MS, Muller  D,  et al.  Meditation or exercise for preventing acute respiratory infection: a randomized controlled trial.  Ann Fam Med. 2012;10(4):337-346.PubMedGoogle ScholarCrossref
35.
Bormann  JE, Gifford  AL, Shively  M,  et al.  Effects of spiritual mantram repetition on HIV outcomes: a randomized controlled trial.  J Behav Med. 2006;29(4):359-376.PubMedGoogle ScholarCrossref
36.
Brewer  JA, Sinha  R, Chen  JA,  et al.  Mindfulness training and stress reactivity in substance abuse: results from a randomized, controlled stage I pilot study.  Subst Abus. 2009;30(4):306-317.PubMedGoogle ScholarCrossref
37.
Brewer  JA, Mallik  S, Babuscio  TA,  et al.  Mindfulness training for smoking cessation: results from a randomized controlled trial.  Drug Alcohol Depend. 2011;119(1-2):72-80.PubMedGoogle ScholarCrossref
38.
Castillo-Richmond  A, Schneider  RH, Alexander  CN,  et al.  Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans.  Stroke. 2000;31(3):568-573.PubMedGoogle ScholarCrossref
39.
Chiesa  A, Mandelli  L, Serretti  A.  Mindfulness-based cognitive therapy versus psycho-education for patients with major depression who did not achieve remission following antidepressant treatment: a preliminary analysis.  J Altern Complement Med. 2012;18(8):756-760.PubMedGoogle ScholarCrossref
40.
Delgado  LC, Guerra  P, Perakakis  P, Vera  MN, Reyes del Paso  G, Vila  J.  Treating chronic worry: psychological and physiological effects of a training programme based on mindfulness.  Behav Res Ther. 2010;48(9):873-882.PubMedGoogle ScholarCrossref
41.
Elder  C, Aickin  M, Bauer  V, Cairns  J, Vuckovic  N.  Randomized trial of a whole-system ayurvedic protocol for type 2 diabetes.  Altern Ther Health Med. 2006;12(5):24-30.PubMedGoogle Scholar
42.
Garland  EL, Gaylord  SA, Boettiger  CA, Howard  MO.  Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: results of a randomized controlled pilot trial.  J Psychoactive Drugs. 2010;42(2):177-192.PubMedGoogle ScholarCrossref
43.
Gaylord  SA, Palsson  OS, Garland  EL,  et al.  Mindfulness training reduces the severity of irritable bowel syndrome in women: results of a randomized controlled trial.  Am J Gastroenterol. 2011;106(9):1678-1688.PubMedGoogle ScholarCrossref
44.
Gross  CR, Kreitzer  MJ, Thomas  W,  et al.  Mindfulness-based stress reduction for solid organ transplant recipients: a randomized controlled trial.  Altern Ther Health Med. 2010;16(5):30-38.PubMedGoogle Scholar
45.
Gross  CR, Kreitzer  MJ, Reilly-Spong  M,  et al.  Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial.  Explore (NY). 2011;7(2):76-87.PubMedGoogle ScholarCrossref
46.
Hebert  JR, Ebbeling  CB, Olendzki  BC,  et al.  Change in women’s diet and body mass following intensive intervention for early-stage breast cancer.  J Am Diet Assoc. 2001;101(4):421-431.PubMedGoogle ScholarCrossref
47.
Jayadevappa  R, Johnson  JC, Bloom  BS,  et al.  Effectiveness of transcendental meditation on functional capacity and quality of life of African Americans with congestive heart failure: a randomized control study.  Ethn Dis. 2007;17(1):72-77.PubMedGoogle Scholar
48.
Jazaieri  H, Goldin  PR, Werner  K, Ziv  M, Gross  JJ.  A randomized trial of MBSR versus aerobic exercise for social anxiety disorder.  J Clin Psychol. 2012;68(7):715-731.PubMedGoogle ScholarCrossref
49.
Kuyken  W, Byford  S, Taylor  RS,  et al.  Mindfulness-based cognitive therapy to prevent relapse in recurrent depression.  J Consult Clin Psychol. 2008;76(6):966-978.PubMedGoogle ScholarCrossref
50.
Lee  SH, Ahn  SC, Lee  YJ, Choi  TK, Yook  KH, Suh  SY.  Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder.  J Psychosom Res. 2007;62(2):189-195.PubMedGoogle ScholarCrossref
51.
Lehrer  PM, Woolfolk  RL, Rooney  AJ, McCann  B, Carrington  P.  Progressive relaxation and meditation: a study of psychophysiological and therapeutic differences between two techniques.  Behav Res Ther. 1983;21(6):651-662.PubMedGoogle ScholarCrossref
52.
Malarkey  WB, Jarjoura  D, Klatt  M.  Workplace based mindfulness practice and inflammation: a randomized trial.  Brain Behav Immun. 2013;27(1):145-154.PubMedGoogle ScholarCrossref
53.
Miller  CK, Kristeller  JL, Headings  A, Nagaraja  H, Miser  WF.  Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study.  J Acad Nutr Diet. 2012;112(11):1835-1842.PubMedGoogle ScholarCrossref
54.
Moritz  S, Quan  H, Rickhi  B,  et al.  A home study-based spirituality education program decreases emotional distress and increases quality of life: a randomized, controlled trial.  Altern Ther Health Med. 2006;12(6):26-35.PubMedGoogle Scholar
55.
Morone  NE, Rollman  BL, Moore  CG, Li  Q, Weiner  DK.  A mind-body program for older adults with chronic low back pain: results of a pilot study.  Pain Med. 2009;10(8):1395-1407.PubMedGoogle ScholarCrossref
56.
Mularski  RA, Munjas  BA, Lorenz  KA,  et al.  Randomized controlled trial of mindfulness-based therapy for dyspnea in chronic obstructive lung disease.  J Altern Complement Med. 2009;15(10):1083-1090.PubMedGoogle ScholarCrossref
57.
Murphy  TJ, Pagano  RR, Marlatt  GA.  Lifestyle modification with heavy alcohol drinkers: effects of aerobic exercise and meditation.  Addict Behav. 1986;11(2):175-186.PubMedGoogle ScholarCrossref
58.
Oken  BS, Fonareva  I, Haas  M,  et al.  Pilot controlled trial of mindfulness meditation and education for dementia caregivers.  J Altern Complement Med. 2010;16(10):1031-1038.PubMedGoogle ScholarCrossref
59.
Paul-Labrador  M, Polk  D, Dwyer  JH,  et al.  Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease.  Arch Intern Med. 2006;166(11):1218-1224.PubMedGoogle ScholarCrossref
60.
Pbert  L, Madison  JM, Druker  S,  et al.  Effect of mindfulness training on asthma quality of life and lung function: a randomised controlled trial.  Thorax. 2012;67(9):769-776.Google ScholarCrossref
61.
Philippot  P, Nef  F, Clauw  L, Romree  M, Segal  Z.  A Randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus.  Clin Psychol Psychother. 2012;19(5):411-419.PubMedGoogle ScholarCrossref
62.
Piet  J, Hougaard  E, Hecksher  MS, Rosenberg  NK.  A randomized pilot study of mindfulness-based cognitive therapy and group cognitive-behavioral therapy for young adults with social phobia.  Scand J Psychol. 2010;51(5):403-410.PubMedGoogle Scholar
63.
Plews-Ogan  M, Owens  JE, Goodman  M, Wolfe  P, Schorling  J.  A pilot study evaluating mindfulness-based stress reduction and massage for the management of chronic pain.  J Gen Intern Med. 2005;20(12):1136-1138.PubMedGoogle ScholarCrossref
64.
Schmidt  S, Grossman  P, Schwarzer  B, Jena  S, Naumann  J, Walach  H.  Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial.  Pain. 2011;152(2):361-369.PubMedGoogle ScholarCrossref
65.
Schneider  RH, Grim  CE, Rainforth  MV,  et al.  Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in blacks.  Circ Cardiovasc Qual Outcomes. 2012;5(6):750-758.PubMedGoogle ScholarCrossref
66.
Segal  ZV, Bieling  P, Young  T,  et al.  Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.  Arch Gen Psychiatry. 2010;67(12):1256-1264.PubMedGoogle ScholarCrossref
67.
SeyedAlinaghi  S, Jam  S, Foroughi  M,  et al.  Randomized controlled trial of mindfulness-based stress reduction delivered to HIV+ patients in Iran: effects on CD4+ T lymphocyte count and medical and psychological symptoms.  Psychosom Med. 2012;74(6):620-627.PubMedGoogle ScholarCrossref
68.
Henderson  VP, Clemow  L, Massion  AO, Hurley  TG, Druker  S, Hebert  JR.  The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial.  Breast Cancer Res Treat. 2012;131(1):99-109.PubMedGoogle ScholarCrossref
69.
Smith  JC.  Psychotherapeutic effects of transcendental meditation with controls for expectation of relief and daily sitting.  J Consult Clin Psychol. 1976;44(4):630-637.PubMedGoogle ScholarCrossref
70.
Taub  E, Steiner  SS, Weingarten  E, Walton  KG.  Effectiveness of broad spectrum approaches to relapse prevention in severe alcoholism: a long-term, randomized, controlled trial of transcendental meditation, EMG biofeedback and electronic neurotherapy.  Alcohol Treat Q. 1994;11(1-2):187-220.Google ScholarCrossref
71.
Koszycki  D, Benger  M, Shlik  J, Bradwejn  J.  Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized social anxiety disorder.  Behav Res Ther. 2007;45(10):2518-2526.PubMedGoogle ScholarCrossref
72.
Whitebird  RR, Kreitzer  M, Crain  AL, Lewis  BA, Hanson  LR, Enstad  CJ.  Mindfulness-based stress reduction for family caregivers: a randomized controlled trial.  Gerontologist. 2013;53(4):676-686.PubMedGoogle ScholarCrossref
73.
Wolever  RQ, Bobinet  KJ, McCabe  K,  et al.  Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial.  J Occup Health Psychol. 2012;17(2):246-258.PubMedGoogle ScholarCrossref
74.
Wong  SY, Chan  FW, Wong  RL,  et al.  Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain: a randomized comparative trial.  Clin J Pain. 2011;27(8):724-734.PubMedGoogle ScholarCrossref
75.
Arch  JJ, Ayers  CR, Baker  A, Almklov  E, Dean  DJ, Craske  MG.  Randomized clinical trial of adapted mindfulness-based stress reduction versus group cognitive behavioral therapy for heterogeneous anxiety disorders.  Behav Res Ther. 2013;51(4-5):185-196.PubMedGoogle ScholarCrossref
76.
Chhatre  S, Metzger  DS, Frank  I,  et al.  Effects of behavioral stress reduction transcendental meditation intervention in persons with HIV.  AIDS Care. 2013;25(10):1291-1297.Google ScholarCrossref
77.
Ferraioli  SJ, Harris  SL.  Comparative effects of mindfulness and skills-based parent training programs for parents of children with autism: feasibility and preliminary outcome data.  Mindfulness. 2013;4(2):89-101.Google ScholarCrossref
78.
Hoge  EA, Bui  E, Marques  L,  et al.  Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity.  J Clin Psychiatry. 2013;74(8):786-792.PubMedGoogle ScholarCrossref
79.
Nakamura  Y, Lipschitz  DL, Kuhn  R, Kinney  AY, Donaldson  GW.  Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial.  Iran Red Crescent Med J. 2013;7(2):165-182.Google Scholar
80.
Omidi  A, Mohammadkhani  P, Mohammadi  A, Zargar  F.  Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms.  Iran Red Crescent Med J. 2013;15(2):142-146.PubMedGoogle ScholarCrossref
81.
Fournier  JC, DeRubeis  RJ, Hollon  SD,  et al.  Antidepressant drug effects and depression severity: a patient-level meta-analysis.  JAMA. 2010;303(1):47-53.PubMedGoogle ScholarCrossref
82.
Hart  W.  The Art of Living: Vipassana Meditation as Taught by S. N. Goenka. Igatpuri, India: Vipassana Research Institute; 2005.
83.
Schulz  KF, Altman  DG, Moher  D; CONSORT Group.  CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.  BMJ. 2010;340:c332. doi:10.1136/bmj.c332.PubMedGoogle ScholarCrossref
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    2 Comments for this article
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    Study methodology likely to underestimate effect sizes of meditation studies
    Paul Grossman | University Hospital Basel, Switzerland
    The authors' decision to exclude RCT trials that only evaluate a waiting list or usual care control is inherently flawed with respect to behavioral intervention studies and is probably responsible for substantial underestimation of effect sizes: 1) In contrast to pharmacological experimental studies, active control procedures in behavioral intervention studies are never equivalent to an inert placebo; plausible active control interventions, therefore, are very likely to include therapeutic aspects that maintain patient motivation and participation across the treatment phase, and may consequently severely reduce the overall effect size of the experimental treatment. 2) Human beings have preferences when it comes to behavioral interventions—some clearly preferring meditation, others another program; using mere common sense, effects of preference are apparent (e.g. Linn et al, 2005) and to be expected in unblinded behavioral intervention trials (which all behavioral intervention trials in the current paper are), in which patients are aware of the treatment they are receiving and the outcome measures are subjective and typically self-reported by the patient. 3) Patients who have strong preferences may refuse to participate; the external validity will, thus, be adversely influenced in a trial in which strong preferences exist, and a large number of patients refuse enrolment and randomization. This will in turn lead to serious limitations of generalizability of the results to the general population. 4) Furthermore when patients who have strong preferences consent to randomization, this is likely also affect its internal validity (e.g. Schmoor et al, 1996). Those who receive preferred treatment are typically more motivated, comply better with treatment and report better outcomes (e.g. Linn et al, 2005; Preference Collaborative Review Group, 2008). Patients not receiving a preferred treatment may experience demoralisation, may be less motivated, may not comply with the treatment regimen, may not provide accurate self-report data during follow-up, and may even drop out of the study, contributing further bias to the internal validity of the trial (e.g. Howard &Thornicroft, 2006; Torgerson & Sibbald, 1998). 5) Demoralized patients who feel they are assigned to the wrong intervention can seriously disrupt the group dynamics of group interventions, such as mindfulness-based programs. These are serious issues that caste serious doubts upon the conclusions of Goyal et al. study. RCTs with waiting list as control procedure is, of course, also not the solution to the problems, but does counter many of the above objections: Humans are recognized as cognizant human beings who often have preferences about how they would like to spend their time and effort. The wait period is not sufficient as placebo but may, in fact, come closer to placebo than most active control programs. Perhaps separate evaluation of each of these types of RCT in a single study might provide a somewhat clearer picture. In any case, ignoring “no treatment” control procedures is just plain wrong. ReferencesLin P, Campbell DG, Chaney EF, Liu CF, Heagerty P, Felker BL, Hedrick SC. The influence of patient preference on depression treatment in primary care. Ann Behav Med. 2005, 30:164-73.Preference Collaborative Review Group. Patients' preferences within randomised trials: systematic review and patient level meta-analysis. BMJ 2008, 337:a1864. Schmoor C, Olschewski M, Schumacher M. Randomized and non-randomized patients in clinical trials: experiences with comprehensive cohort studies. Stat Med 1996 15:263-271. Torgerson DJ, Sibbald B. Understanding controlled trials. What is a patient preference trial? BMJ 1998, 316:360.
    CONFLICT OF INTEREST: None Reported
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    Mindfulness-based interventions in routine clinical care for stress-related ailments
    David S Black PhD MPH, Jeffrey M Greeson PhD | Keck School of Medicine University of Southern California, Perelman School of Medicine University of Pennsylvania
    The meta-analysis by Goyal et al. (1) appraises evidence on the efficacy of mainstreamed meditation programs that target stress-related outcomes in adult clinical populations. The authors concluded that mindfulness-based interventions (MBIs) (N=36 trials) showed statistically significant and clinically relevant effects for anxiety, depression, pain, stress/distress, and quality of life whereas other forms of meditation did not yield such effects. The observed effects support efforts that aim to integrate MBIs into routine healthcare recommendations made by clinicians, especially for patients who are interested in and receptive to the approach. We interpret the positive evidence from the review to indicate an opportunity for clinicians to recommend MBIs as a means to help patients engage in a participatory process of care. To support this recommendation, here we briefly compare effects sizes between MBIs and other commonly used clinical recommendations for stress-related ailments.According to Goyal, MBIs confer an average beneficial effect size of 0.30 on depressive symptoms at 8 weeks with effects lasting up to 6 months. For comparison, the overall mean effect size for commonly prescribed antidepressant medications for mild to moderate depression is 0.17 or below. (2) Further, based on trials that include active controls, MBIs can yield stronger effects on depression than the national recommended levels of physical activity, (3) and can yield comparable or stronger effects than relaxation training in head-to-head comparisons. (4) Similar comparisons can be made for anxiety, pain, and quality of life outcomes. (5) There were too few trials with active control groups in the Goyal et al. review to reliably determine effects on other important stress-related outcomes such as substance use, eating behavior, and sleep. Consequently, the evidence-base for MBIs is not developed enough at this time to make confident recommendations for these particular conditions. Recent special issues of other journals however, have made marked advances in elucidating the psychological, neurobiological, and behavioral pathways through which MBIs and mindfulness meditation practice can alleviate common stress-related symptoms such as smoking, unhealthy eating, and social anxiety, and can modulate brain structure, function, and connectivity. (6,7,8) Healthcare problems involving stress-related ailments are prevalent and costly, and it is essential that these ailments be adequately addressed to help patients move in the direction of taking personal accountability for pursuing optimal health. Where anxiety, depression, pain, stress/distress, and mental health-related quality of life appear relevant, clinicians should consider recommending MBIs to their patients along with other routine care recommendations. This approach is important considering that only 3% of primary care office visits include counseling on stress management, (9) presumably due to lack of time. Thus, MBIs offer patients the opportunity to be more proactive in their own health care by helping them make a persistent and sometimes daily effort in self-care and stress management, typically setting the intention for lasting lifestyle change. MBIs have a role in the future of medical care as they focus on putting day-to-day participation in health back in the hands of patients.References1. Goyal M, Singh S, Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-Being. JAMA Int Med. 2014;174:357-368.2. Fournier JC, DeRubeis RJ, Hollon SD, et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303:47-53.3. Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database of Syst Rev. 2013;9:CD004366.4. Jain S, Shapiro SL, Swanick S, et al. A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Beh Med. 2007;33:11-21.5. Jensen MP, Day MA, Miró J. Neuromodulatory treatments for chronic pain: efficacy and mechanisms. Nat Rev Neurol. 2014;10:167-178.6. Black DS. Mindfulness-Based Interventions: An Antidote to Suffering in the Context of Substance Use, Misuse, and Addiction. Subst Use Misuse. 2014;49:487-491.7. Tang Y-Y, Posner MI. Special issue on mindfulness neuroscience. Soc Cogn Affect Neurosci. 2013;8:1.8. O'Reilly GA, Cook L, Spruijt-Metz D, Black DS. Mindfulness-based interventions for obesity-related eating behaviours: a literature review. Obesity Reviews. 2014;15:453-461.9. Nerurkar A, Bitton A, Davis RB, Phillips RS, Yeh G. When Physicians Counsel About Stress: Results of a National Study. JAMA Int Med. 2013;173:76-77.
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    Original Investigation
    March 2014

    Meditation Programs for Psychological Stress and Well-being: A Systematic Review and Meta-analysis

    Author Affiliations
    • 1Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
    • 2Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
    • 3Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
    • 4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
    JAMA Intern Med. 2014;174(3):357-368. doi:10.1001/jamainternmed.2013.13018
    Abstract

    Importance  Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation.

    Objective  To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health–related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations.

    Evidence Review  We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals.

    Findings  After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health–related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies).

    Conclusions and Relevance  Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.

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