Meditation for Psychological Stress and Well-being

Meditation for Psychological Stress and Well-being | Complementary and Alternative Medicine | JAMA Internal Medicine – Jan 2014

Importance  Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation.

Objective  To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health–related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations.  

Findings  After reviewing 18 753 citations, we included 47 trials with 3515 participants.

Mindfulness meditation programs had moderate evidence of improved

  • anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months),
  • depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and
  • pain (0.33 [0.03- 0.62]) and
  • low evidence of improved stress/distress and mental health–related quality of life.

We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight.

We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies).

Conclusions and Relevance

Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress.

Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress.

Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.

To counsel patients appropriately, clinicians need to know more about meditation programs and how they can affect health outcomes.

Meditation training programs vary in several ways, including the type of mental activity promoted, the amount of training recommended, the use and qualifications of an instructor, and the degree of emphasis on religion or spirituality.

Some meditative techniques are integrated into a broader alternative approach that includes dietary and/or movement therapies (eg, ayurveda or yoga).

Reviews to date report a small to moderate effect of mindfulness and mantra meditation techniques in reducing emotional symptoms (eg, anxiety, depression, and stress) and improving physical symptoms (eg, pain).

These reviews have largely included uncontrolled and controlled studies, and many of the controlled studies did not adequately control for placebo effects (eg, waiting list– or usual care–controlled studies).

Observational studies have a high risk of bias owing to problems such as self-selection of interventions (people who believe in the benefits of meditation or who have prior experience with meditation are more likely to enroll in a meditation program and report that they benefited from one) and use of outcome measures that can be easily biased by participants’ beliefs in the benefits of meditation.

Clinicians need to know whether meditation training has beneficial effects beyond self-selection biases and the nonspecific effects of time, attention, and expectations for improvement.

The objective of this systematic review is to evaluate the effects of meditation programs on negative affect (eg, anxiety, stress), positive affect (eg, well-being), the mental component of health-related quality of life, attention, health-related behaviors affected by stress (eg, substance use, sleep, eating habits), pain, and weight among persons with a clinical condition

We include only RCTs that used 1 or more control groups in which the amount of time and attention provided by the control intervention was comparable to that of the meditation program.

Discussion

Mindfulness meditation programs, in particular, show small improvements in anxiety, depression, and pain with moderate evidence and small improvements in stress/distress and the mental health component of health-related quality of life with low evidence when compared with nonspecific active controls.

Anxiety, depression, and stress/distress are different components of negative affect.

When we combined each component of negative affect, we saw a small and consistent signal that any domain of negative affect is improved in mindfulness programs when compared with a nonspecific active control.

Among the 9 RCTs evaluating the effect on pain, we found moderate evidence that mindfulness-based stress reduction reduces pain severity to a small degree when compared with a nonspecific active control, yielding an ES of 0.33 from the meta-analysis.

This effect is variable across painful conditions and is based on the results of 4 trials, of which 2 were conducted in patients with musculoskeletal pain, 1 trial in patients with irritable bowel syndrome, and 1 trial in a population without pain

  • Visceral pain had a large and statistically significant relative 30% improvement in pain severity, whereas
  • musculoskeletal pain showed 5% to 8% improvements that were considered nonsignificant.

Below, he describes a problem that I feel is very relevant: meditation was not ever meant to be a “quick fix”.

The real practice of meditation and mindfulness requires years of study and practice – it cannot be dispensed as a prescription to treat a specific medical problem.

Historically, meditation was not conceptualized as an expedient therapy for health problems.

Meditation was a skill or state one learned and practiced over time to increase one’s awareness and through this awareness to gain insight and understanding into the various subtleties of one’s existence.

Training the mind in awareness, in nonjudgmental states, or in the ability to become completely free of thoughts or other activity are daunting accomplishments.

The interest in meditation that has grown during the past 30 years in Western cultures comes from Eastern traditions that emphasize lifelong growth.

The translation of these traditions into research studies remains challenging.

Long-term trials may be optimal to examine the effect of meditation on many health outcomes, such as those trials that have evaluated mortality.

However, many of the studies included in this review were short-term (eg, 2.5 h/wk for 8 weeks), and the participants likely did not achieve a level of expertise needed to improve outcomes that depend on mastery of mental and emotional processes.

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.