The past 30 years have seen exponential growth in research examining Mindfulness-Based Stress Reduction (MBSR) and a variety of offshoots termed Mindfulness-Based Interventions (MBIs). The Mindfulness Research Guide, a website launched in 2009, presents a comprehensive overview of this bourgeoning science, including a graph (below) demonstrating the growth in mindfulness research literature from 1980-2013.
Although concerns have been expressed regarding methodological weaknesses inherent in the literature (e.g. small sample sizes, lack of randomization, suboptimal controls, use of self-report as measures of improvement), meta-analyses and review articles support the usefulness of MBIs for a broad range of issues and populations (Baer 2003; Grossman et al. 2004; Hofmann et al. 2010). Below are some noteworthy studies.
Physical Health Outcomes
Mindfulness research that focuses on physiological and medical outcomes has primarily used MBSR as an intervention. In fact, Kabat-Zinn originally developed MBSR for patients suffering from a variety of chronic pain syndromes. Studies demonstrate that participants significantly improved pain levels, mood, and psychiatric symptoms from pre- to post MBSR (Kabat-Zinn 1982; Kabat-Zinn et al. 1985), as well as in comparison to those who only had the pain clinic’s usual treatment (Kabat-Zinn et al. 1985). Follow-up assessments revealed that although pain ratings returned to baseline within about 6 months, general distress and psychological symptoms remained improved (Kabat-Zinn et al. 1987).
Spurred by these initial results, researchers began to apply MBSR to more specific pain conditions. Notoriously difficult to treat, fibromyalgia (FM) is a syndrome characterized by widespread body pain, and is also associated with fatigue, sleep problems, headaches, depression and anxiety. A pre-post design resulted in 51% of patients indicating moderate to marked improvements in pain levels, FM symptoms, fatigue, sleep, coping and well-being (Kaplan et al. 1993). In a quasi-experimental design, women with FM were assigned to either MBSR or an active support condition. Those in MBSR showed greater improvements on measures of pain, quality of life, coping, anxiety, depression, and somatic complaints, and these results were sustained 3 years later (Grossman et al. 2007). Lower back pain has also received attention in the literature. In one study, participants were randomized to MBSR or a wait-list control group, and those taking MBSR reported greater improvements on measures of chronic pain acceptance, engagement in activities, and overall physical functioning (Morone et al. 2008).
In addition to treating chronic pain, MBSR has been used with patients suffering from a variety of other physical conditions. People with breast and prostate cancer demonstrated lower levels of cortisol (a primary stress hormone) and normalized immune function (Carlson et al. 2007; Witnek-Janusek et al. 2008). People with HIV infection demonstrated increases in natural killer cell activity (a first line of defense against viral infection), increases in β-chemokines (molecules that block HIV from infecting healthy immune cells) (Robinson et al. 2003), and protection from the loss of “helper” T-cells over time (Creswell et al. 2009). And people with chronic heart failure demonstrated reduced anxiety and depression and significantly better symptoms of chronic heart failure at one year compared with control subjects (Sullivan et al. 2009).
There is also increasing evidence to support the effect of MBIs in the treatment of psoriasis (Kabat-Zinn et al. 1998), type 2 diabetes (Rosenzweig et al. 2007), and rheumatoid arthritis (Zautra et al. 2008), among many other conditions. In addition to ameliorating symptoms of a number of disorders, research consistently shows that mindfulness: 1) reduces distress that often accompanies chronic illness, and 2) increases well-being and quality of life (Brown et al. 2007; Grossman et al. 2004; Ludwig & Kabat-Zinn 2008; Shigaki et al. 2006).
Mental Health Outcomes
Mindfulness has also increasingly been incorporated into psychotherapeutic interventions. A 2010 meta-analysis (Hofman et al.) reviewed 39 studies examining the effects of MBSR and Mindfulness-Based Cognitive Therapy (MBCT) on 1,140 participants diagnosed with generalized anxiety disorder, depression, and other psychiatric or medical conditions (including cancer). In the overall sample, effect sizes demonstrated moderate improvement in anxiety (Hedges’ g = 0.63) and mood symptoms (Hedges’ g = 0.59) from pre to post-treatment. In patients with anxiety and mood disorders, effect sizes were robust for both anxiety (Hedges’ g = 0.97) and mood disorders (Hedges’ g = 0.95).
MBIs have become a central aspect of other psychological treatment protocols, with positive results. Dialectical Behavioral Therapy (DPT) was developed for people with borderline personality disorder (BPD), a difficult-to-treat condition involving long-term turbulent emotions, impulsive actions, and chaotic relationships. Combining mindfulness with cognitive-behavioral techniques, DBT has been the first intervention to demonstrate moderate efficacy in treating BPD (Öst, 2008). Acceptance and Commitment Therapy (ACT) mixes mindfulness and acceptance strategies with commitment and behavior-change strategies. Contrasted with traditional cognitive behavioral therapy (which teaches people to control their thoughts, feelings, sensations, and memories), ACT teaches them to notice, accept, and embrace their private events. A review of outcome studies (Ruiz 2010) demonstrates its efficacy in a wide range of problems, even at follow-up. ACT shows strong support for pain, moderate support for depression, and preliminary support for smoking, substance abuse, and some anxiety disorders (ACBS 2008).
In addition to the research in clinical populations, mindfulness techniques appear to benefit healthy individuals. Physiological studies have found that: 1) women who completed MBSR and continued to meditate had higher amounts of melatonin metabolites (broad spectrum anti-oxidants) than non-meditators (Massion et al. 1995), 2) university students who were randomly assigned to a body scan meditation had greater increases in parasympathetic cardiovascular activity compared to the progressive muscle relaxation and wait-list conditions (Ditto et al. 2006), and 3) adults who completed MBSR had stronger immune responses to an influenza vaccine compared to those on the wait list (Davidson et al. 2003).
There are also psychological studies that support the use of MBIs in healthy populations. An experience-sampling study (Brown & Ryan 2003) demonstrates that mindfulness predicts positive emotional states and autonomous activities (engaging in behavior in accordance with ones values). A recent review and meta-analysis (Chiesa & Seretti 2009) examined the impact of MBSR on stress reduction in healthy subjects. Compared to both an inactive control and a structurally equivalent program, MBSR reduced stress and enhanced spirituality values. Compared to standard relaxation training, both treatments equally reduced stress. However, MBSR had the added benefits of reducing ruminative thinking and trait anxiety, and increasing empathy and self-compassion. Overall, the preliminary research investigating mindfulness in healthy communities shows promise.
Even though mindfulness programs are emerging in numerous workplace settings, the literature concerning the impact on employees is in its infancy. Initial results, however, parallel the physical and emotional outcomes found in earlier studies. A randomized, controlled trial for 179 full-time workers compared a group practicing mental silence meditation to both a relaxation active control and a wait-list control. The meditation group showed significant reductions in work stress and depressed mood compared to the control groups (Manocha et al. 2011). Another randomized, controlled trial (Wolever et al. 2012) for 239 employees compared two mind-body interventions (a mindfulness-based program and therapeutic yoga) with a control group that participated only in assessment. The mind-body interventions showed greater improvements on perceived stress, sleep quality, and the heart rhythm coherence ratio of heart rate variability. Both studies demonstrate the effectiveness and viability of integrating mindfulness interventions into the workplace.
A body of literature has begun to explore the neural mechanisms involved in mindfulness meditation. Some of the research focuses on attention, such as the examination of whether mindfulness training modifies distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring (Jha & Baime 2007). One of the many findings suggests that participation in MBSR improves the ability to orient attention. Two separate studies comparing adult meditators and non-meditators found that regular meditation is associated with: 1) better orienting and executive attention (van den Hurk et al. 2010), and 2) more accurate, efficient, and flexible visual processing across diverse tasks that have high face validity outside of the laboratory and beyond meditation practice (Hodgins & Adair 2010). All of these outcomes support the possibility of increasing different aspects of attention through mindfulness training.
Neuroimaging studies are also exploring the way in which mindfulness mediation is mediated through underlying brain processes. One study randomly assigned healthy women to either MBSR or an 8-week waiting period, after which functional connectivity magnetic resonance imagining (fcMRI) data was acquired while subjects attended to scanner sounds with their eyes closed. Findings suggest that MBSR significantly alters intrinsic functional connectivity through a more consistent attentional focus, enhanced sensory processing, and reflective awareness of sensory experience (Kilpatrick et al. 2011). Another study used voxel-based morphometry to compare brain analyses of 16 healthy, meditation-naïve MBSR participants to 17 individuals in the wait-list control. Findings suggest that MBSR participation is associated with increases in gray matter concentration within brain regions (left hippocampus, posterior cingulate cortex, temporo-parietal junction, and cerebellum) involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking (Holzel et al. 2011).
Investigating whether mindfulness practices impact on safety is extremely new territory. Only a few studies have begun to explore this possibility, and those have focused on driving.
In one study, university students who learned mindfulness exercises in a Buddhist psychology course were compared to students in a human factors psychology course who were not taught these techniques. The Buddhist psychology students scored significantly higher on a measure of concentration, though differences in mindfulness were not significant. Situation awareness, assessed using a query method in a driving simulator, was significantly related to both mindfulness and concentration levels (rs = 0.80 and 0.61, respectively). Results indicate that mindfulness training may improve driving performance by increasing environmental awareness, and enabling people to block out distractions and to quickly identify hazards (Kass et al. 2011).
Another study (Feldman et al. 2011) with young-adult drivers used a path analysis to investigate if texting-while-driving was mediated by the degree to which individuals: 1) text as a means of reducing unpleasant emotions, and 2) limit texting in order to focus on the present-moment. Individuals lower in mindfulness reported more frequent texting-while-driving, which appeared to be a means of regulating negative emotions.
Association for Contextual Behavioral Science (ACTS). 2008. State of the ACT Evidence. http://contextualpsychology.org/state_of_the_act_evidence/
Baer, R. A. 2003. Mindfulness training as clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice. 10, 125-143.
Brown, K. W., Ryan, R. M. 2003. The benefits of being present: Mindfulness and its role in psychological well-being. Journals of Personality and Social Psychology. 84(4), 822-48.
Brown K. W., Ryan R. M., Creswell J. D. 2007. Mindfulness: Theoretical foundations and evidence for salutary effects. Psychological Inquiry. 18, 211–237.
Carlson, L. E., Speca, M., Faris, P., Patel, K. 2007. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer patients. Brain, Behavior, and Immunity. 21, 1038–1049.
Chiesa, A. Serretti, A. 2009. MBSR for stress management in healthy people: A review and meta-analysis. Journal of Alternative and Complementary Medicine. 15(5), 593-600.
Creswell, J. D., Myers, H. F., Cole, S. W., Irwin, M. R. 2009. Mindfulness meditation training effect son CD4+ T lymphocytes in HIV-1 infected adults: a small randomized controlled trial. Brain, Behavior and Immunity. 23, 184–188.
Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., Urbanowski, F., Harrington, A., Bonus, K., Sheridan, J.F. 2003. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine. 65, 564-570.
Ditto, B., Eclache, M., Goldman, N. 2006. Short-term autonomic and cardiovascular effects of mindfulness body scan meditation. Annals of Behavioral Medicine. 32, 227-234.
Feldman, G., Greeson, J., Renna, M., Robbins-Monteith, K. 2011. Mindfulness predicts less texting while driving among young adults: Examining attention- and emotion-regulation motives as potential mediators. Personality and Individual Differences. 51(7), 856-861.
Grossman, P., Niemann, L., Schmidt, S., Walach, H. 2004. Mindfulness-Based stress reduction and health benefits. A meta-analysis. Journal of Psychosomatic Research. 57(1), 35-43.
Grossman, P, Tiefenthaler-Gilmer U., Raysz A., Kesper U. 2007. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics. 76(4), 226-233.
Hodgins, H. S., Adair, K. C. 2010. Attentional processes and meditation. Consciousness and Cognition. 19(4), 872-8.
Hofmann, S. G., Sawyer, A. T., Witt, A. A., Oh, D. 2010. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology. 78(2), 169–183.
Holzel. B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., Lazar, S. W. 2011. Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research. 191, 36–43.
Jha, A. P., Krompinger, J., Baime, M. J. 2007. Mindfulness training modifies subsystems of attention. Cognitive Affective and Behavioral Neuroscience. 7, 109-119.
Kabat-Zinn, J. 1982. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. General Hospital Psychiatry. 4(1), 33-47.
Kabat-Zinn, J., Lipworth, L. Burney, R. 1985. The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine. 8, 163-190.
Kabat-Zinn, J., Lipworth, L., Burney, R., Sellers, W. 1987. Four-Year follow-up of a meditation-based program for the self-regulation of chronic pain: Treatment outcomes and compliance. Clinical Journal of Pain. 2(3), 159-173.
Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A., Scharf, M. J., Cropley, T. G., Hosmer, D., Bernhard, J. D. 1998. 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). Psychosomatic Medicine. 60, 625–632.
Kass, S. J., VanWormer, L. A., Mikulas, W. L., Legan, S., Bumgarner, D. 2011. Effects of Mindfulness Training on Simulated Driving: Preliminary Results. Personality and Individual Differences. 51(7), 856–861.
Kilpatrick, L. A., Suyenobu, B. Y., Smith, S. R., Bueller, J. A., Goodman, T., Creswell, J. D., Tillisch, K., Mayer, E. A., Naliboff, B. D. 2011. Impact of Mindfulness-Based Stress Reduction training on intrinsic brain connectivity. Neuroimage. 56(1), 290-8.
Ludwig, D. S., Kabat-Zinn, J. 2008. Mindfulness in medicine. Journal of the American Medical Association. 300, 1350–1352.
Manocha, R., Black, D., Sarris, J., Stough, C. 2011. A Randomized, Controlled Trial of Meditation for Work Stress, Anxiety and Depressed Mood in Full-Time Workers. Evidence-Based Complementary and Alternative Medicine. 1-8.
Morone, N. E., Greco, C. M., Weinder, D. K. 2008. Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study. Pain. 134(3), 310-319.
Massion, A. O., Teas, J., Hebert, J. R., Wertheimer, M. D., Kabat-Zinn, J. 1995. Meditation, melatonin and breast/prostate cancer: Hypothesis and preliminary data. Medical Hypotheses. 44, 39-46.
Öst, L. G. 2008. Efficacy of the third wave of behavioral therapies: A systematic review and meta-analysis. Behaviour Research and Therapy. 46, 296–321.
Robinson, F. P., Mathews, H. L., Witek-Janusek, L. 2003. Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with Human Immunodeficiency Virus: A quasi-experimental study. The Journal of Alternative and Complementary Medicine. 9, 683–694.
Rosenzweig, S., Reibel, D. K., Greeson, J. M., Edman, J. S., Jasser, S. A., McMearty, K. D., Goldstein, B. J. 2007. Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative Therapies in Health and Medicine. 13, 36–38.
Ruiz, F. J. 2010. A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy. 10, 125-162.
Shigaki, C. L., Glass, B., Schopp, L. H. 2006. Mindfulness-based stress reduction in medical settings. Journal of Clinical Psychology in Medical Settings.13, 209–216.
Sullivan, M. J., Wood, L., Terry, J., Brantley, J., Charles, A., McGee, V., Johnson, D., Krucoff, M., Rosenberg, B., Bosworth, H. B., Adams, K., Cuffe, M. S. 2009. The Support, Education, and Research in Chronic Heart Failure Study (SEARCH): A mindfulness-based psychoeducational intervention improves depression and clinical symptoms in patients with chronic heart failure. American Heart Journal. 157(1), 84-90.
van den Hurk, P. A., Giommi, F., Gielen, S. C., Speckens, A.E., Barendregt, H.P. 2010. Greater efficiency in attentional processing related to mindfulness meditation. Quarterly Journal of Experimental Psychology. 63(6), 1168-80.
Witek-Janusek, L., Albuquerque, K., Rambo Chroniak K, Chroniak C, Durazo-Arvizu R, Mathews H. 2008. Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain, Behavior, and Immunity. 22, 969–981.
Wolever, R. Q., Bobinet, K. J., McCabe, K., Mackenzie, E. R., Fekete, E., Kusnick, C. A., Baime, M. 2012. Effective and viable mind-body stress reduction in the workplace: A randomized controlled trial. Journal of Occupational Health Psychology. 17(2), 246-258.
Zautra, A. J., Davis, M. C., Reich, J. W., Nicassario, P., Tennen, H., Finan, P., Kratz, A., Parrish, B., Irwin, M.R. 2008. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. Journal of Consulting and Clinical Psychology. 76,408–421.
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