Meditation programs for psychological stress and well-being

A systematic review and meta-analysis

Madhav Goyal, Sonal Singh, Erica Sibinga, Neda F Gould, Anastasia Rowland-Seymour, Ritu Sharma, Zackary Berger, Dana Sleicher, David D. Maron, Hasan M. Shihab, Padmini Ranasinghe, Shauna Linn, Shonali Saha, Eric B Bass, Jennifer Haythornthwaite

Research output: Contribution to journalArticle

Abstract

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. EVIDENCE REVIEW: We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. 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.

Original languageEnglish (US)
Pages (from-to)357-368
Number of pages12
JournalJAMA Internal Medicine
Volume174
Issue number3
DOIs
StatePublished - 2014

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Meditation
Psychological Stress
Meta-Analysis
Mental Health
Feeding Behavior
Sleep
Anxiety
Quality of Life
Depression
Mindfulness
Weights and Measures
Pain
Placebo Effect
Insurance Benefits
MEDLINE
Libraries
Randomized Controlled Trials
Confidence Intervals
Exercise
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Meditation programs for psychological stress and well-being : A systematic review and meta-analysis. / Goyal, Madhav; Singh, Sonal; Sibinga, Erica; Gould, Neda F; Rowland-Seymour, Anastasia; Sharma, Ritu; Berger, Zackary; Sleicher, Dana; Maron, David D.; Shihab, Hasan M.; Ranasinghe, Padmini; Linn, Shauna; Saha, Shonali; Bass, Eric B; Haythornthwaite, Jennifer.

In: JAMA Internal Medicine, Vol. 174, No. 3, 2014, p. 357-368.

Research output: Contribution to journalArticle

Goyal, Madhav ; Singh, Sonal ; Sibinga, Erica ; Gould, Neda F ; Rowland-Seymour, Anastasia ; Sharma, Ritu ; Berger, Zackary ; Sleicher, Dana ; Maron, David D. ; Shihab, Hasan M. ; Ranasinghe, Padmini ; Linn, Shauna ; Saha, Shonali ; Bass, Eric B ; Haythornthwaite, Jennifer. / Meditation programs for psychological stress and well-being : A systematic review and meta-analysis. In: JAMA Internal Medicine. 2014 ; Vol. 174, No. 3. pp. 357-368.
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abstract = "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. EVIDENCE REVIEW: We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95{\%} confidence intervals. 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.",
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AU - Rowland-Seymour, Anastasia

AU - Sharma, Ritu

AU - Berger, Zackary

AU - Sleicher, Dana

AU - Maron, David D.

AU - Shihab, Hasan M.

AU - Ranasinghe, Padmini

AU - Linn, Shauna

AU - Saha, Shonali

AU - Bass, Eric B

AU - Haythornthwaite, Jennifer

PY - 2014

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N2 - 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. EVIDENCE REVIEW: We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. 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.

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