Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis

doi:10.1016/j.brat.2017.12.002

Behaviour Research and Therapy

Volume 102, March 2018, Pages 25-35

https://doi.org/10.1016/j.brat.2017.12.002 Get rights and content

Highlights

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We investigated mindfulness exercises as a stand-alone intervention.
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Stand-alone mindfulness exercises exhibit positive effects on anxiety and depression.
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Future studies should investigate effects in clinical samples.

Abstract

Mindfulness-based interventions (MBIs) are currently well established in psychotherapy with meta-analyses demonstrating their efficacy. In these multifaceted interventions, the concrete performance of mindfulness exercises is typically integrated in a larger therapeutic framework. Thus, it is unclear whether stand-alone mindfulness exercises (SAMs) without such a framework are beneficial, as well. Therefore, we conducted a systematic review and meta-analysis regarding the effects of SAMs on symptoms of anxiety and depression. Systematic searching of electronic databases resulted in 18 eligible studies (n = 1150) for meta-analyses. After exclusion of one outlier SAMs had small to medium effects on anxiety (SMD = 0.39; CI: 0.22, 0.56; PI: 0.07, 0.70; p < .001, I² = 18.90%) and on depression (SMD = 0.41; CI: 0.19, 0.64; PI: −0.05, 0.88; p < .001; I² = 33.43%), when compared with controls. Summary effect estimates decreased, but remained significant when corrected for potential publication bias. This is the first meta-analysis to show that the mere, regular performance of mindfulness exercises is beneficial, even without being integrated in larger therapeutic frameworks.

Section snippets

Eligibility criteria

The systematic review and meta-analysis were designed and conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRSIMA; Moher, Liberati, Tetzlaff, & Altman, 2009) statement. Inclusion criteria were specified in advance and documented in a protocol at PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=33441).

Study selection

The initial database search yielded 8181 results, 2405 new records were found after updating the search. 52 additional records were identified through reference lists of eligible studies (Fig. 1). After removal of duplicates, the initial abstract screening led to an exclusion of 8524 studies. The independent full-text screening of 578 articles found that 21 studies met inclusion criteria. Agreement between raters was high with only three studies being rated differently (κ = 0.93, z = 22.4,

Discussion

A core element of mindfulness as taught in MBIs refers to the regular performance of formal mindfulness exercises. Yet, the efficacy of these exercises as a stand-alone intervention is seldom explored, since most studies investigate fully-fletched MBIs, which are composed of several components (Dimidjian and Segal, 2015, Mander et al., 2017). Therefore, the aim of the present systematic review and meta-analysis was to isolate one specific component and sight the existing evidence concerning the

Funding

This research was supported by a grant from the German Research Foundation (DFG) to Dr. Johannes Mander (MA6526/2-1).

Contributors

PB and JM designed the study and wrote the protocol. Independent screening and data extraction of eligible studies was conducted by PB and SP. PB conducted the statistical analysis and wrote the first draft of the manuscript. TH, PK, BD, HB and JM critically revised the manuscript for important intellectual content. All authors contributed to and have approved the final manuscript.

Acknowledgements

We would like to thank Jana Nusskern, Luise Prüssner, Ivo Ritter, Kamala Grothe, Hanna Deflorin, Elena Gruber and Clara Janinhoff for their intensive support in realizing this study.

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View full text

Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis

Highlights

Abstract

Section snippets

Eligibility criteria

Study selection

Discussion

Funding

Contributors

Acknowledgements

Mindfulness training as a clinical intervention: A conceptual and empirical review

Clinical Psychology: Science and Practice

Meditative practice cultivates mindfulness and reduces anxiety, depression, blood pressure, and heart rate in a diverse sample

Journal of Cognitive Psychotherapy

Mindfulness: A proposed operational definition

Clinical Psychology: Science and Practice

Introduction to meta-analysis

Effectiveness of brief mindfulness techniques in reducing symptoms of anxiety and stress

Mindfulness

A randomised controlled trial of a brief online mindfulness-based intervention

Behaviour Research and Therapy

Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions

Clinical Psychology Review

A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students

Nurse Education Today

Mindfulness based cognitive therapy for psychiatric disorders: A systematic review and meta-analysis

Psychiatry Research

The effectiveness of daily mindful breathing practices on test anxiety of students

PLoS One

The benefits of meditation vis-à-vis emotional intelligence, perceived stress and negative mental health

Stress Health: Journal International Society Investigation Stress

Statistical power analysis for the behavioral sciences

Turning towards or turning away: A comparison of mindfulness meditation and guided imagery relaxation in patients with acute depression

Behavioural and Cognitive Psychotherapy

The effects of adaptive working memory training and mindfulness meditation training on processing efficiency and worry in high worriers

Behaviour Research and Therapy

Training teachers to deliver mindfulness-based interventions: Learning from the UK experience

Mindfulness

Competence in teaching mindfulness-based courses: Concepts, development and assessment

Mindfulness

Meta-analysis in clinical trials

Controlled Clinical Trials

Prospects for a clinical science of mindfulness-based intervention

American Psychologist

Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis

Biometrics

Bias in meta-analysis detected by a simple, graphical test

BMJ : British Medical Journal

Mindfulness-based stress reduction and mindfulness-based cognitive therapy—a systematic review of randomized controlled trials

Acta Psychiatrica Scandinavica

Enduring effects of evidence-based psychotherapies in acute depression and anxiety disorders versus treatment as usual at follow-up–a longitudinal meta-analysis

Clinical Psychology Review

Meditation programs for psychological stress and well-being: A systematic review and meta-analysis

JAMA Intern Med

How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies

Clinical Psychology Review

Statistical Methods for Meta-analysis.

Measuring inconsistency in meta-analyses

BMJ

The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review

Journal of Consulting and Clinical Psychology

Putting the ‘app’ in happiness: A randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing

Journal of Happiness Studies

A multisite pre/post study of mindfulness training for therapists: The impact on session presence and effectiveness

Journal of Cognitive Psychotherapy

The effects of a short-term mindfulness based intervention on self-reported mindfulness, decentering, executive attention, psychological health, and coping style: Examining unique mindfulness effects and mediators

Mindfulness

An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results

General Hospital Psychiatry

Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness

Mindfulness-based therapy: A comprehensive meta-analysis

Clinical Psychology Review