Long-term Mental Health Effects of Mindfulness Training: a 4-Year Follow-up Study

Abstract

Objectives. Mindfulness-based stress reduction (MBSR) enhances short-term psychological health in clinical and non-clinical samples, whereas studies examining long-term effects are scarce. This study examined whether the effects of a 7-week MBSR programme on mental health persisted at 2-and 4-year follow up and explored possible mechanisms of effect. Methods. In a two-site randomized controlled trial, 288 medical and psychology students were allocated to an MBSR intervention (n = 144) or a no-treatment control group (n = 144). During the 4-year follow-up period, the MBSR group was offered 90-min booster sessions semi-annually. The primary outcome measures were mental distress (General Health Questionnaire-GHQ) and well-being; these were measured at baseline (T0) and postintervention follow-up at 1 month (T1), 2 years (T1) and again at 4 years (T3). Secondary outcomes included coping, mindfulness, and meditation practice. Results. At 4-year follow up, the MBSR group showed significantly better scores on mental distress, mindfulness, avoidance coping, and problem-focused coping (Cohen's d = 0.23-0.42). Meditation practice positively predicted long-term mindfulness scores. Short-term effects in mindfulness-scores mediated long-term intervention effects in mental distress and coping. However, reversed mediation also was observed (i.e. changes in outcome mediating long-term mindfulness scores), and this indicates that initial changes in outcome and mindfulness are intrinsically intertwined and may both influence long-term effects. Small post-intervention effects on well-being and seeking social support did not persist at follow up. Conclusions. MBSR fostered enduring effects on mental distress and coping in medical and psychology students 4 years post-intervention.

Six-year positive effects of a mindfulness-based intervention on mindfulness, coping and well-being in medical and psychology students; Results from a randomized controlled trial

“…Details regarding home mindfulness practice frequency and duration during the four-year follow-up period can be found in Solhaug 2017 [ 40 ]. During the six-year follow-up period, the number of participants in the intervention group who reported to practice formal mindfulness exercises decreased from 112 of 140 (80%), one month after the intervention to 28 of 48 (58%), at six-year follow-up, while it increased in the control group from 35 of 138 (25%) to 21 of 58 (36%) participants.…”

“…Intervention effects are striking, given the relatively low dose of the intervention (a 15-hour course over seven weeks plus 8 x 1 ½ hour booster sessions over four years), the fact that almost half of the students declined to participate in booster sessions offered once a term, and, the intervention group’s decline in frequency of home mindfulness practice over time in contrast with the control group’s increase in practice. While the number of students that reported practicing mindfulness was higher in the intervention group at all time points, better adherence to practice in the intervention group might have led to more robust results, as frequency of formal mindfulness practice has been shown to predict levels of mental distress in the short term [ 41 ], and dispositional mindfulness in the long term [ 40 ]. Another factor that could have influenced the results was the higher baseline levels of AFC in the dropouts compared to the completers.…”

“…All participants had agreed to participate in this study hoping to receive mindfulness training, and many pursued mindfulness training on their own during the follow-up period. Hence, the presence of “contamination” as a cause of weakening the effects observed in mental distress in the four-year follow-up cannot be ruled out [ 40 ]. This may also have weakened the strength of the current findings.…”

“…Post-intervention data from the current trial found increased use of PFC following the MBI, and students, high on neuroticism scores, showed reduced AFC [ 39 ]. These changes were maintained at two and four-year follow-up [ 40 ].…”

Effectiveness of providing university students with a mindfulness-based intervention to increase resilience to stress: 1-year follow-up of a pragmatic randomised controlled trial

“…32 Analyses of associations between formal practice after the course and follow-up outcomes are scarce and inconsistent. [33][34][35] Very few studies have assessed the frequency and effects of informal mindfulness practice, 33 in part because of the difficulties in measuring it. 36 A recent dose-response analysis found that informal practice was associated with improved positive emotions with no association with negative emotions.…”