Mental health, mindfulness and meditation
A literature review
Dr Ian Gawler OAM, BVSc, MCounsHS. November 2020.

Summary - Mindfulness and meditation are evidence based

There is a strong body of evidence mindfulness and meditation can have therapeutic benefits for those dealing with a wide range of mental health issues - stress, anxiety, depression and more. There is also good evidence online programs are useful, and that these programs can significantly assist those caring for people affected by mental health issues.

Want key scientific articles to share with family, friends or health professionals who need convincing? Need a little reassurance yourself? Just want the facts?

Currently if one searches “mindfulness and meditation research”, Google comes up with around 17.6 million results. A bit daunting. So while what follows is no PhD, here are some of the top, recent articles (mostly meta- analyses) that highlight this rapidly expanding yet already solid evidence base.

1. Reducing stress and anxiety with online mindfulness

Spijkerman MP et al. 2016, Clin Psych review, Vol 45, 102 114.

Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials.

The authors reported online Meditation- Based Interventions have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.

2. App use improves mental health

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.

3. Stress, anxiety and depression reduction; improvements in mental and physical health

From the American Psychological Association website, 2019 Creswell JD and Khoury B. Mindfulness meditation: A research-proven way to reduce stress : Mindfulness meditation can improve both mental and physical health.

Researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for reducing stress, anxiety and depression. Mindfulness can also help treat people with specific problems including depression, pain, smoking and addiction. Some of the most promising research has looked at people with depression. Several studies have found, for example, that MBCT can significantly reduce relapse in people who have had previous episodes of major depression. What is more, mindfulness-based interventions can improve physical health too. For example, mindfulness may reduce pain, fatigue and stress in people with chronic pain. Other studies have found preliminary evidence that mindfulness might boost the immune system and help people recover more quickly from cold or flu.

4. Reducing stress and anxiety with mindfulness based therapy

Khoury B et al. Mindfulness-based therapy: A comprehensive meta-analysis; 2013 Clin Psych Review vol 33, 6, 763 - 771.

Meta-analysis (review) of studies evaluating Mindfulness Based Therapy – a specific form of mindfulness. The authors concluded “MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.”

5. Reducing (symptoms) psychological distress

Coffey, K. A., & Hartman, M. (2008). Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress. Complementary Health Practice Review, 13(2), 79–91.

The authors reported their results confirmed an inverse relationship between mindfulness and psychological distress.

6. Anxiety, mood disorders and accelerating healing

Arias et al. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006;12(8):817‐832.

While there have been few studies examining the specific question of meditation’s influence on healing in general, early studies are positive.

The authors reported the strongest evidence for efficacy was found for epilepsy, symptoms of the premenstrual syndrome and menopausal symptoms. Benefit was also demonstrated for mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. They stated their results support the safety and potential efficacy of meditative practices for treating certain illnesses, particularly in nonpsychotic mood and anxiety disorders.

7. Reducing depression and fatigue; improving sleep

Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(4):494–501.

Following this randomised clinical trial, the author’s reported Mindfulness Awareness Practices showed significant improvement relative to the Sleep Hygiene Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity.

8. Reducing stress and anxiety with meditation

Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68.

This meta-analysis reviewed 18,753 citations, however, only 47 trials with 3515 participants met the stringent criteria to be included in the final analysis – having randomized clinical trials with active controls for placebo.

The authors concluded meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Specifically, there was found to be moderate evidence of improved anxiety, depression and pain, with lower evidence of improved stress/distress and mental health-related quality of life.

9. Depression and mindfulness

Research on Mindfulness Based Cognitive Therapy (MBCT) has found that these techniques more than halve the relapse rate for people who have had depression - from 78% to 36%. Meditation changes our relationship to negative thoughts and emotions giving a non-attachment to them and therefore, we are not controlled by them so much.

Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects: J Consult Clin Psychol. 2004;72(1):31-40.

10. Adolescents and mindfulness

In adolescents, mindfulness reduces symptoms of anxiety, depression, and somatic distress, and increases self-esteem and sleep quality.

Biegel et al. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial: Journal of consulting and clinical psychology (2009) vol. 77 (5) pp. 855-66.

11. Burn-out in doctors and mindfulness

For professionals with high stress loads such as doctors, Mindfulness has also been found to enhance wellbeing, reduce burnout and mood disturbance with increased empathy and responsiveness to their patients.

Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians: JAMA. 2009 Sep 23;302(12):1338-40.

Conclusion

There is a solid evidence base for mindfulness and meditation being used to help people affected by mental health issues (including their carers). These interventions can reduce symptoms associated with stress, anxiety and depression, as well as assist in recovery.

Also, there is good evidence online mindfulness - based programs such as the Allevi8 App have positive benefits and these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.