Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy – a systematic review of randomized controlled trials
TL;DR: Fjorback LO, Arendt M, Ørnbøl E, Fink P, Walach H. Mindfulness‐Based Stress Reduction and Mindfulness-Based Cognitive Therapy – a systematic review of randomized controlled trials.
Abstract: Fjorback LO, Arendt M, Ornbol E, Fink P, Walach H. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy – a systematic review of randomized controlled trials.
Objective: To systematically review the evidence for MBSR and MBCT.
Method: Systematic searches of Medline, PsycInfo and Embase were performed in October 2010. MBSR, MBCT and Mindfulness Meditation were key words. Only randomized controlled trials (RCT) using the standard MBSR/MBCT programme with a minimum of 33 participants were included.
Results: The search produced 72 articles, of which 21 were included. MBSR improved mental health in 11 studies compared to wait list control or treatment as usual (TAU) and was as efficacious as active control group in three studies. MBCT reduced the risk of depressive relapse in two studies compared to TAU and was equally efficacious to TAU or an active control group in two studies. Overall, studies showed medium effect sizes. Among other limitations are lack of active control group and long-term follow-up in several studies.
Conclusion: Evidence supports that MBSR improves mental health and MBCT prevents depressive relapse. Future RCTs should apply optimal design including active treatment for comparison, properly trained instructors and at least one-year follow-up. Future research should primarily tackle the question of whether mindfulness itself is a decisive ingredient by controlling against other active control conditions or true treatments.
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TL;DR: Mindfulness-based therapy is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.
1,491 citations
Cites background from "Mindfulness-Based Stress Reduction ..."
...Moreover, little is known about the stability of treatment gains (Baer, 2003; Hofmann et al., 2010), about the active ingredients that may account for the efficacy of MBT (Chiesa & Serretti, 2011; Fjorback et al., 2011), and about the relevant moderator variables....
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...…and the clinical andmindfulness training and practical experience of the therapists delivering MBT (Carmody & Baer, 2009; Crane, Barnhofer, Hargus, Amarasinghe, & Winder, 2010; Davidson, 2010; Fjorback et al., 2011; Piron, 2001; Pradhan et al., 2007; Segal, Teasdale, Williams, & Gemar, 2002)....
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...…(de Vibe et al., 2012; Hofmann et al., 2010; Klainin-Yobas et al., 2012; Sedlmeier et al., 2012), homework practice (e.g., Carmody & Baer, 2009; Fjorback et al., 2011; Toneatto & Nguyen, 2007), course attendance (de Vibe et al., 2012), and the clinical andmindfulness training and practical…...
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TL;DR: All in all, mindfulness-based interventions in children and youths hold promise, particularly in relation to improving cognitive performance and resilience to stress, however, the diversity of study samples, variety in implementation and exercises, and wide range of instruments used require a careful and differentiated examination of data.
Abstract: Mindfulness programs for schools are popular. We systematically reviewed the evidence regarding the effects of school-based mindfulness interventions on psychological outcomes, using a comprehensive search strategy designed to locate both published and unpublished studies. Systematic searches in 12 databases were performed in August 2012. Further studies were identified via hand search and contact with experts. Two reviewers independently extracted the data, also selecting information about intervention programs (elements, structure etc.), feasibility, and acceptance. Twenty-four studies were identified, of which 13 were published. Nineteen studies used a controlled design. In total, 1,348 students were instructed in mindfulness, with 876 serving as controls, ranging from grade 1 to 12. Overall effect sizes were Hedge's g = 0.40 between groups and g = 0.41 within groups (p < 0.0001). Between group effect sizes for domains were: cognitive performance g = 0.80, stress g = 0.39, resilience g = 0.36, (all p < 0.05), emotional problems g = 0.19 third person ratings g = 0.25 (both n.s.). All in all, mindfulness-based interventions in children and youths hold promise, particularly in relation to improving cognitive performance and resilience to stress. However, the diversity of study samples, variety in implementation and exercises, and wide range of instruments used require a careful and differentiated examination of data. There is great heterogeneity, many studies are underpowered, and measuring effects of Mindfulness in this setting is challenging. The field is nascent and recommendations will be provided as to how interventions and research of these interventions may proceed.
718 citations
TL;DR: The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders and provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.
Abstract: Objectives: To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. Methods: Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. Results: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care.
643 citations
Cites background from "Mindfulness-Based Stress Reduction ..."
...MBCT and ACT Recently developed structured therapies, such as mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT) have not been evaluated as thoroughly as CBT and IPT, but appear to be effective in reducing depressive symptoms and in preventing relapse of depression (specificity for subtype and/or severity of depression remains unclear) (Fjorback et al., 2011)....
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TL;DR: Low-quality evidence is found that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs, suggesting additional well-designed, rigorous, and large-scale RCTS are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.
Abstract: Background
Chronic pain patients increasingly seek treatment through mindfulness meditation.
535 citations
TL;DR: Among adults with chronic low back pain, treatment with 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 M BSR and CBT.
Abstract: Importance Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. Objective To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care. Design, Setting, and Participants Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113). Interventions CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received. Main Outcomes and Measures Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. Results There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overallP = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overallP = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes. Conclusions and Relevance Among adults with chronic low back pain, treatment with 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. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain. Trial Registration clinicaltrials.gov Identifier:NCT01467843
480 citations
References
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01 Dec 1969TL;DR: The concepts of power analysis are discussed in this paper, where Chi-square Tests for Goodness of Fit and Contingency Tables, t-Test for Means, and Sign Test are used.
Abstract: Contents: Prefaces. The Concepts of Power Analysis. The t-Test for Means. The Significance of a Product Moment rs (subscript s). Differences Between Correlation Coefficients. The Test That a Proportion is .50 and the Sign Test. Differences Between Proportions. Chi-Square Tests for Goodness of Fit and Contingency Tables. The Analysis of Variance and Covariance. Multiple Regression and Correlation Analysis. Set Correlation and Multivariate Methods. Some Issues in Power Analysis. Computational Procedures.
115,069 citations
TL;DR: Correlational, quasi-experimental, and laboratory studies show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced self-awareness.
Abstract: Mindfulness is an attribute of consciousness long believed to promote well-being. This research provides a theoretical and empirical examination of the role of mindfulness in psychological well-being. The development and psychometric properties of the dispositional Mindful Attention Awareness Scale (MAAS) are described. Correlational, quasi-experimental, and laboratory studies then show that the MAAS measures a unique quality of consciousness that is related to a variety of well-being constructs, that differentiates mindfulness practitioners from others, and that is associated with enhanced selfawareness. An experience-sampling study shows that both dispositional and state mindfulness predict self-regulated behavior and positive emotional states. Finally, a clinical intervention study with cancer patients demonstrates that increases in mindfulness over time relate to declines in mood disturbance and stress. Many philosophical, spiritual, and psychological traditions emphasize the importance of the quality of consciousness for the maintenance and enhancement of well-being (Wilber, 2000). Despite this, it is easy to overlook the importance of consciousness in human well-being because almost everyone exercises its primary capacities, that is, attention and awareness. Indeed, the relation between qualities of consciousness and well-being has received little empirical attention. One attribute of consciousness that has been much-discussed in relation to well-being is mindfulness. The concept of mindfulness has roots in Buddhist and other contemplative traditions where conscious attention and awareness are actively cultivated. It is most commonly defined as the state of being attentive to and aware of what is taking place in the present. For example, Nyanaponika Thera (1972) called mindfulness “the clear and single-minded awareness of what actually happens to us and in us at the successive moments of perception” (p. 5). Hanh (1976) similarly defined mindfulness as “keeping one’s consciousness alive to the present reality” (p. 11). Recent research has shown that the enhancement of mindfulness through training facilitates a variety of well-being outcomes (e.g., Kabat-Zinn, 1990). To date, however, there has been little work examining this attribute as a naturally occurring characteristic. Recognizing that most everyone has the capacity to attend and to be aware, we nonetheless assume (a) that individuals differ in their propensity or willingness to be aware and to sustain attention to what is occurring in the present and (b) that this mindful capacity varies within persons, because it can be sharpened or dulled by a variety of factors. The intent of the present research is to reliably identify these inter- and intrapersonal variations in mindfulness, establish their relations to other relevant psychological constructs, and demonstrate their importance to a variety of forms of psychological well-being.
9,818 citations
"Mindfulness-Based Stress Reduction ..." refers background in this paper
...Mindfulness, defined as moment-to-moment nonjudgemental awareness, is a skill that can be learned through practice, and it is believed to promote wellbeing (1)....
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01 Jan 2005
TL;DR: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness book.
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15 Jan 2008
TL;DR: In this paper, the authors used the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness book to help people cope with stress, pain, and illness.
Abstract: FULL CATA STROPHE LIV ING: USING THE W ISDOM OF YOUR BODY A ND MIND TO FA CE STRESS, PA IN, A ND ILLNESS To read Full Catastrophe Living : Using the W isdom of Your Body and Mind to Face Stress, Pain, and Illness eBook, please click the link under and download the ebook or get access to additional information which might be related to Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness book.
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TL;DR: In this paper, a review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions, and suggests that these interventions may be helpful in the treatment of several disorders.
Abstract: Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.
4,204 citations
"Mindfulness-Based Stress Reduction ..." refers background in this paper
...The improved self-observation may promote use of better coping skills (6)....
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...It incorporates elements of cognitive therapy facilitating a detached or decentred view of one s thoughts and is designed to prevent depressive relapse (6)....
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...Baer (6) concludes that although the empirical literature includes many methodological flaws, mindfulness-based interventions may be helpful in the treatment of several disorders....
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...Unlike many health promoting and cognitive behavioural approaches (6), mindfulness training focuses solely on cultivating inner resources, rather than changing what is wrong with the person....
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