Mindfulness Based Stress Reduction (MBSR) for Improving Health, Quality of Life, and Social Functioning in Adults

Abstract

Mind‐body interventions to manage stress‐related health problems are of widespread interest. One of the best known methods is mindfulness‐based stress reduction (MBSR), and MBSR courses are now offered by health services, as well as in social and welfare settings. In this systematic review, we report on the effects of MBSR interventions on health, quality of life, and social functioning. From the more than 3,000 potentially relevant references identified in two extensive searches, we included 31 relevant studies with an overall total of 1,942 participants, each of whom had been randomised to receive MBSR or other treatment strategies (most often a waiting list control).We utilised all outcome data published in the selected studies using a new statistical method for calculating the effect size. This method addressed the problems presented by the interdependence of many measurements of outcomes. 26 of the 31 studies were identified as having data suitable for meta‐analysis.MBSR was found to have a moderate and consistent positive effect on mental health outcomes in both patients selected with somatic problems and with mild to moderate psychological problems, and among participants recruited from community settings. MBSR interventions improved outcomes measuring different aspects of personal development and quality of life. The effects on somatic health outcomes were somewhat smaller. No adverse effects were described. Few studies were found that evaluated the impact of MBSR on social functioning, such as the ability to work.Key messagesMind‐body interventions to manage stress‐related health problems are of widespread interest. One of the best known methods is mindfulness‐based stress reduction (MBSR), and MBSR courses are now offered by health services, as well as in social and welfare settings. In this systematic review, we report on the effects of MBSR interventions on health, quality of life, and social functioning. From the more than 3,000 potentially relevant references identified in two extensive searches, we included 31 relevant studies with an overall total of 1,942 participants, each of whom had been randomised to receive MBSR or other treatment strategies (most often a waiting list control). We utilised all outcome data published in the selected studies using a new statistical method for calculating the effect size. This method addressed the problems presented by the interdependence of many measurements of outcomes.26 of the 31 studies were identified as having data suitable for meta‐analysis. MBSR was found to have a moderate and consistent positive effect on mental health outcomes in both patients selected with somatic problems and with mild to moderate psychological problems, and among participants recruited from community settings. MBSR interventions improved outcomes measuring different aspects of personal development and quality of life. The effects on somatic health outcomes were somewhat smaller. No adverse effects were described. Few studies were found that evaluated the impact of MBSR on social functioning, such as the ability to work.Executive summary/AbstractBACKGROUNDStress and distress are common experiences central to many of the problems occupying health and social services and efforts to improve both health and quality of life are receiving increasing attention. Evaluative research on mind‐body interventions is also growing and one of the best studied efforts to reduce stress is mindfulness‐based stress reduction (MBSR). Developed by Kabat‐Zinn in 1979, MBSR is based on old spiritual traditions and includes regular meditation. Mindfulness is a way of intentionally attending to the present moment in a non‐judgemental way. A number of reviews and meta‐analyses on MBSR have been conducted, but few have adhered to the meta‐analytic protocol stipulated by the Cochrane and Campbell collaborations. The last review of all relevant target groups was published in 2004.OBJECTIVESTo evaluate the effect of mindfulness‐based stress reduction (MBSR) on health, quality of life, and social functioning in adults.SEARCH STRATEGYWe searched all relevant databases: MEDLINE, AMED, PsycINFO, EMBASE, Ovid Nursing Full Text Plus, the British Nursing Index and Archive, the Cochrane Central Register of Controlled Trials (CENTRAL), SIGLE, Web of Science®, SveMed+, Dissertation Abstracts International, ERIC, Social Services Abstracts, Sociological Abstracts, the International Bibliography of Social Sciences, and ProQuest. The searches were conducted in July 2008 and again in September 2010.SELECTION CRITERIARandomised controlled trials on all target groups were included where the intervention followed the MBSR protocol developed by Kabat‐Zinn, allowing for variations in the length of the MBSR courses. We accepted all types of control groups and no language restrictions were imposed.DATA COLLECTION AND ANALYSISTwo reviewers independently read the titles, retrieved the studies, and extracted data from all the included studies. We calculated standardised mean differences (expressed as Hedges' g‐values) from all of the study outcomes using Comprehensive Meta Analysis. The meta‐analyses were undertaken using the Metafor Package which is part of the statistical program ‘R’; we used a newly developed technique (Robust Standard Errors) to address the statistical challenge presented by clusters of internally correlated effect estimates.RESULTSWe identified 31 RCTs with an overall total of 1,942 participants. Seven studies included people with mild to moderate psychological problems, 13 studies targeted people with various somatic conditions, and 11 studies recruited people from the general population. 26 of the 31 RCTs were used for the meta‐analyses (an overall total of 1,456 persons). All effect sizes are expressed using Hedges' g‐values, and positive values indicate beneficial effects. Post‐intervention effect sizes were as follows: for measures of anxiety 0.53 (95% CI 0.43, 0.63), for depression 0.54 (95% CI 0.35, 0.74), and for stress/distress 0.56 (95% CI 0.44, 0.67). The overall effect size post‐intervention for the combined outcome ‘mental health’ was 0.53 (95% CI ‐0.43, 0.64). Heterogeneity was low and tau square‐values (for between‐study variance) ranged from 0 to 0.03. The results for measures of personal development were 0.50 (95% CI 0.35, 0.66), quality of life 0.57 (95% CI 0.17, 0.96), mindfulness 0.70 (95% CI 0.05, 1.34), and somatic health 0.31 (95% CI 0.10, 0.52). Results for quality of life and mindfulness showed moderate to large heterogeneity.Effect sizes for the combined mental health outcomes were relatively similar across the range of target groups: 0.50 for clinical and 0.62 for non‐clinical populations and this difference is not significant. Likewise the effect size was 0.51 both for people recruited because of a somatic condition and for those with a mental health problem. Effect sizes for mental health were not particularly influenced by the length of intervention, self‐reported practice, risk of bias, or whether analyses were done as intention to treat or per protocol, but they were positively correlated with course attendance. Only nine studies included follow‐up data; the effects diminished over time except in one study in which refresher classes were held. Very little data were found on social functioning, and no information at all on side effects and costs.AUTHORS' CONCLUSIONSMBSR has a moderate and consistent effect on a number of measures of mental health for a wide range of target groups. It also appears to improve measures of personal development such as empathy and coping, and enhance both mindfulness, quality of life and improve some aspects of somatic health. Hardly any included studies measured either social function or work ability. There is a paucity of data on long‐term effects.