Systematic review and individual participant data meta-analysis of randomized controlled trials assessing mindfulness-based programs for mental health promotion

Abstract

Mindfulness-based programs (MBPs) are widely used to prevent mental ill health. Evidence suggests beneficial average effects but wide variability. We aimed to confirm the effect of MBPs and to understand whether and how baseline distress, gender, age, education, and dispositional mindfulness modify the effect of MBPs on distress among adults in non-clinical settings. We conducted a systematic review and individual participant data (IPD) meta-analysis (PROSPERO CRD42020200117). Databases were searched in December 2020 for randomized controlled trials satisfying a quality threshold and comparing in-person, expert-defined MBPs with passive-control groups. Two researchers independently selected, extracted and appraised trials using the revised Cochrane Risk-of-Bias tool. IPD of eligible trials were sought from authors. The primary outcome was psychological distress (unpleasant mental or emotional experiences including anxiety and depression) at 1 to 6 months after program completion. Data were checked and imputed if missing. Pairwise, random-effects, two-stage IPD meta-analyses were conducted. Effect modification analyses followed a within-studies approach. Stakeholders were involved throughout this study. Fifteen trials were eligible; 13 trialists shared IPD (2,371 participants representing 8 countries. In comparison with passive-control groups, MBPs reduced average distress between 1 and 6 months post-intervention with a small to moderate effect size (standardized mean difference, −0.32; 95% confidence interval, −0.41 to −0.24; P < 0.001; no heterogeneity). Results were robust to sensitivity analyses and similar for the other timepoint ranges. Confidence in the primary outcome result is high. We found no clear indication that this effect is modified by the pre-specified candidates. Group-based teacher-led MBPs generally reduce psychological distress among volunteering community adults. More research is needed to identify sources of variability in outcomes at an individual level.

Prevalence and 20-year Trends in Meditation, Yoga, Guided Imagery and Progressive Relaxation Use Among US Adults From 2002 to 2022

“…While growth in meditation use has been strong over the past 20 years, our analysis using 5 timepoints revealed a more stable rate of growth than the previously most recent estimates which suggested threefold growth between 2012-2017 5 alone. Increases in accessibility 52 , evidence regarding health and wellbeing benefits [10][11][12] , and barriers to accessing conventional mental health services 38,39 may be contributing to increases in use across all practices. The widespread accessibility of meditation apps may explain why growth in meditation use has been stronger than for yoga and guided imagery/progressive relaxation.…”

“…Despite the documented benefits of meditation and yoga to mental health and wellbeing [10][11][12][13] , they encompass a wide variety of approaches that are not equivalent, and there is significant variability in the availability and quality of evidence for different practices (see e.g., Van Dam et al, 2018 for discussion of meditation 21 ). Currently, there is insufficient evidence for meditation, yoga, and guided imagery/progressive relaxation to make specific recommendations about who is most likely to benefit from which practice or for which problem, how barriers to access can be reduced for underrepresented groups, how specific practices may interact with other interventions, or which practices may be contraindicated for certain individuals or groups [41][42][43] .…”

“…The use of meditation, yoga, guided imagery, progressive relaxation and other complementary and alternative medical (CAM) practices by US adults has grown five-fold since the 1950s [1][2][3][4][5][6][7][8] . While CAM (also known as Integrative Medicine) practices include over 500 different approaches 9 , meditation, yoga, guided imagery, and progressive relaxation are among the most popular 4 , with potential benefits to mental health and wellbeing [10][11][12] that are comparable in efficacy to psychotherapy and pharmacotherapy 13 . The practice of meditation, in particular, was introduced to the West through migration and cultural exchange where it was strategically adapted into secular formats to be empirically assessed, which led to greater acceptance within medical and mental health care systems 14 .…”

Effectiveness of mindfulness-based interventions on the well-being of healthcare workers: a systematic review and meta-analysis

“…A previous meta-analysis on mindfulness-based programmes for promoting mental health also separated psychological distress measures measured less than 1 month after programme completion versus those measured months after programme completion. 23 Subgroup analyses were performed for the mode of intervention delivery and occupation. Sensitivity analyses were performed using the leave-one-out method.…”

Mind the Echo Chamber: Mindfulness as a Contemplative Practice That can Contribute to Public Health

“…Despite the strong associations between mindfulnessbased programs and health outcomes, it is still very unclear what the specific components, outcomes, and mechanisms of this intervention are (Galante et al, 2023;Goldberg et al, 2018). Measures of dispositional mindfulness were created to provide an operationalization of what changes in mindfulness-based programs (see e.g., Baer, 2011).…”