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Meditation Programs for Psychological Stress and Well-Being
Comparative Effectiveness Reviews, No. 124
Investigators: Madhav Goyal, MD, MPH, Sonal Singh, MD, MPH, Erica MS Sibinga, MD, MHS, Neda F Gould, PhD, Anastasia Rowland-Seymour, MD, Ritu Sharma, BSc, Zackary Berger, MD, PhD, Dana Sleicher, MS, MPH, David D Maron, MHS, Hasan M Shihab, MBChB, MPH, Padmini D Ranasinghe, MD, MPH, Shauna Linn, BA, Shonali Saha, MD, Eric B Bass, MD, MPH, and Jennifer A Haythornthwaite, PhD.
Author Information and AffiliationsStructured Abstract
Objectives:
Meditation, a mind-body method, employs a variety of techniques designed to facilitate the mind's capacity to affect bodily function and symptoms. An increasing number of patients are using meditation programs despite uncertainty about the evidence supporting the health benefits of meditation. We aimed to determine the efficacy and safety of meditation programs on stress-related outcomes (e.g., anxiety, depression, stress, distress, well-being, positive mood, quality of life, attention, health-related behaviors affected by stress, pain, and weight) compared with an active control in diverse adult clinical populations
Data sources:
We searched MEDLINE®, PsycINFO®, Embase®, PsycArticles, SCOPUS, CINAHL, AMED, and the Cochrane Library in November 2012. We also performed manual searches.
Review methods:
We included randomized controlled trials with an active control that reported on the stress outcomes of interest. Two reviewers independently screened titles to find trials that reported on outcomes, and then extracted data on trial characteristics and effect modifiers (amount of training or teacher qualifications). We graded the strength of evidence (SOE) using four domains (risk of bias, precision, directness, and consistency). To assess the direction and magnitude of reported effects of the interventions, we calculated the relative difference between groups in how each outcome measure changed from baseline. We conducted meta-analysis using standardized mean differences to obtain aggregate estimates of effects with 95-percent confidence intervals (CIs). We analyzed efficacy trials separately from comparative effectiveness trials.
Results:
After a review of 17,801 citations, we included 41 trials with 2,993 participants. Most trials were short term, but they ranged from 4 weeks to 9 years in duration. Trials conducted against nonspecific active controls provided efficacy data. Mindfulness meditation programs had moderate SOE for improvement in anxiety (effect size [ES], 0.40; CI, 0.08 to 0.71 at 8 weeks; ES, 0.22; CI, 0.02 to 0.43 at 3–6 months), depression (ES, 0.32; CI, −0.01 to 0.66 at 8 weeks; ES, 0.23; CI, 0.05 to 0.42 at 3–6 months); and pain (ES, 0.33; CI, 0.03 to 0.62); and low SOE for improvement in stress/distress and mental health–related quality of life. We found either low SOE of no effect or insufficient SOE of an effect of meditation programs on positive mood, attention, substance use, eating, sleep, and weight. In our comparative effectiveness analyses, we did not find any evidence to suggest that these meditation programs were superior to any specific therapies they were compared with. Only 10 trials had a low risk of bias. Limitations included clinical heterogeneity, variability in the types of controls, and heterogeneity of the interventions (e.g., dosing, frequency, duration, technique).
Conclusions:
Meditation programs, in particular mindfulness programs, reduce multiple negative dimensions of psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health as well as stress-related behavioral outcomes.
Contents
- Addendum
- Preface
- Acknowledgments
- Key Informants
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Results of the Search
- Description of Types of Trials Retrieved
- Key Question Results
- Key Question 1 What are the efficacy and harms of meditation programs on negative affect (e.g., anxiety, stress) and positive affect (e.g., well-being) among those with a clinical condition (medical or psychiatric)?
- Key Question 2 What are the efficacy and harms of meditation programs on attention among those with a clinical condition (medical or psychiatric)?
- Key Question 3 What are the efficacy and harms of meditation programs on health-related behaviors affected by stress, specifically substance use, sleep, and eating, among those with a clinical condition (medical or psychiatric)?
- Key Question 4 What are the efficacy and harms of meditation programs on pain and weight among those with a clinical condition (medical or psychiatric)?
- Discussion
- Key Question 1 What are the efficacy and harms of meditation programs on negative affect (e.g., anxiety, stress) and positive affect (e.g., well-being) among those with a clinical condition (medical or psychiatric)?
- Key Question 2 What are the efficacy and harms of meditation programs on attention among those with a clinical condition (medical or psychiatric)?
- Key Question 3 What are the efficacy and harms of meditation programs on health-related behaviors affected by stress, specifically substance use, sleep, and eating, among those with a clinical condition (medical or psychiatric)?
- Key Question 4 What are the efficacy and harms of meditation programs on pain and weight among those with a clinical condition (medical or psychiatric)?
- Harm Outcomes for All Key Questions
- Limitations of the Primary Studies
- Limitations of the Review
- Future Directions
- Conclusions
- References
- Appendix A Abbreviations and Glossary of Terms
- Appendix B Detailed Search Strategies
- Appendix C Screening Forms
- Appendix D Excluded Studies
- Appendix E Evidence Tables
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10061-I. Prepared by: Johns Hopkins University Evidence-based Practice Center, Baltimore, MD
Suggested citation:
Goyal M, Singh S, Sibinga EMS, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation Programs for Psychological Stress and Well-Being. Comparative Effectiveness Review No. 124. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061–I.) AHRQ Publication No. 13(14)-EHC116-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
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.ahrq.gov
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