What Works in Mindfulness Interventions for Medically Unexplained Symptoms? A Systematic Review

Abstract

Background/Purpose: Mindfulness-based interventions (MBIs) have been used in medically unexplained symptoms (MUS). This systematic review describes the literature investigating the general effect of MBIs on MUS and identifies the effects of specific MBIs on specific MUS conditions. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Guidelines (PRISMA) and the modified Oxford Quality Scoring System (Jadad score) were applied to the review, yielding an initial 1,556 articles. The search engines included PubMed, ScienceDirect, Web of Science, Scopus, EMBASE, and PsychINFO using the search terms: mindfulness, or mediations, or mindful or MBCT or MBSR and medically unexplained symptoms or MUS or Fibromyalgia or FMS. A total of 24 articles were included in the final systematic review. Results/Conclusions: MBIs showed large effects on: symptom severity (d = 0.82), pain intensity (d =0.79), depression (d = 0.62), and anxiety (d = 0.67). A manualized MBI that applies the four fundamental elements present in all types of interventions were critical to efficacy. These elements were psycho-education sessions specific to better understand the medical symptoms, the practice of awareness, the nonjudgmental observance of the experience in the moment, and the compassion to ones’ self. The effectiveness of different mindfulness interventions necessitates giving attention to improve the gaps that were identified related to home-based practice monitoring, competency training of mindfulness teachers, and sound psychometric properties to measure the mindfulness practice.

Trajectories of change in symptom severity in patients with fibromyalgia: exploratory analyses of a randomised controlled trial

“…This finding corresponds to a recent systematic review investigating the general effects of mindfulness-and acceptance-based interventions and suggesting that a qualified supervisor oversaw the facilitators to ensure faithful adherence to the mindfulness theoretical fundamentals (206). However, the mindfulness-and acceptance-based interventions emphasise a dynamic relationship between facilitators and participants that is not easy to capture and measure.…”

“…Another systematic review and meta-analysis that included cognitive-behavioural therapy, MBCT, and ACT showed reduced FM symptoms such as pain, negative mood, and disability compared to control interventions (205). A recent systematic review that investigated the general effects of mindfulness-based interventions (MBSR, MBCT) in medically unexplained symptoms, including FM, showed beneficial effects on symptom severity, pain intensity, depression, and anxiety (206). We had also predefined fatigue, psychological distress, and work ability as outcome measures in the SR, but these measures were not assessed separately in any of the included studies.…”

Efficacy of mindfulness- and acceptance-based cognitive-behavioral therapies for bodily distress in adults: a meta-analysis

“…Hence, all of these three “third wave” therapies could have a positive impact on emotion regulation processes and interrupt patients' reinforcement processes related to their symptoms ( 8 ), thus also reducing comorbid depression and anxiety ( 4 ). Efficacy of these therapies has already been shown for some specific functional somatic syndromes or symptoms [e.g., ( 9 , 10 )]. However, no meta-analysis in the field provides sufficient evidence for “third wave“ therapies taking into account recent changes in classification.…”

Does the practice of mindfulness reduce somatic symptoms and COVID-19-related anxiety? A community-based survey

“…This increase in emotion regulation is crucial in patients with somatic complaints as a lack of emotional awareness and an overuse of maladaptive emotion regulation strategies are considered basic psychological liabilities of Somatic Symptom Disorder (Waller and Scheidt, 2004;Garnefski et al, 2017;Okur Güney et al, 2019). Previous research has shown that mindfulness meditation can have a positive impact on some aspects of somatization, such as symptom severity and pain intensity, and on comorbid anxiety and depression (Hoge et al, 2013;Lakhan and Schofield, 2013;Aucoin et al, 2014;Hilton et al, 2017;Hazlett-Stevens, 2018;Billones et al, 2020). However, the body of evidence prevents strong conclusions, as available studies are mostly based on mindfulness interventions, in which social determinants, such as the relationship with the instructor and the group, have been found to be stronger predictors than specific mindfulness practice-related factors on psychological outcomes (Canby et al, 2021).…”