JAMA Intern Med 2014 Jan 06;[EPub Ahead of Print], M Goyal, S Singh, EM Sibinga, NF Gould, A Rowland-Seymour, R Sharma, Z Berger, D Sleicher, DD Maron, HM Shihab, PD Ranasinghe, S Linn, S Saha, EB Bass, JA Haythornthwaite
Research · January 22, 2014
TAKE-HOME MESSAGE
- This review of 47 RCTs enrolling 3515 participants found moderate evidence that mindfulness programs focused on meditation can provide small improvements in anxiety, depression, and pain. Results showed low evidence of stress/distress reduction and metal health–related quality of life. Little or no evidence was found for a benefit in mood, attention, substance use, eating habits, sleep, or weight.
- More rigorous studies are needed to explore the effects of meditation programs on improving mental health and stress-related behavior.
Commentary By: David Rakel MD, FAAFP
Meditation Works for Anxiety, Depression, and Visceral Pain
Meditation has many different forms, but most include focusing well on one thing. The focus can be on the present moment, as in mindfulness, or a mantra, as in transcendental meditation. These were the two most common types of meditation evaluated in this meta-analysis, showing effects similar to antidepressants for anxiety and depression. Mindfulness was also found to reduce visceral pain by about 30% (but not as much for musculoskeletal pain); so, consider this for patients with irritable bowel syndrome or reflux disease.
Mindfulness is paying attention to the present moment, on purpose and without judgment. It gets the mind out of memories of the past or desires for the future or the recurring stories that the mind plays over and over. Practice helps one see life as it truly is, and not as the conditioned mind perceives it to be. In fact, practicing mindfulness on one patient at a time can improve diagnostic skills and increase the joy in this profession. Give it a try. The next time you are with a patient and your mind wanders to how many patients are waiting for you, simply bring your attention to the patient in front of you, focusing on one person well.
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.
JAMA internal medicine
Meditation Programs for Psychological Stress and Well-Being: A Systematic Review and Meta-Analysis
JAMA Intern Med 2014 Jan 06;[EPub Ahead of Print], M Goyal, S Singh, EM Sibinga, NF Gould, A Rowland-Seymour, R Sharma, Z Berger, D Sleicher, DD Maron, HM Shihab, PD Ranasinghe, S Linn, S Saha, EB Bass, JA Haythornthwaite