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.
During menopause women experience vasomotor and psychosexual symptoms that cannot entirely be alleviated with hormone replacement therapy (HRT). Besides, HRT is contraindicated after breast cancer.
To review the evidence on the effectiveness of psychological interventions in reducing symptoms associated with menopause in natural or treatment-induced menopausal women.
Medline/Pubmed, PsycINFO, EMBASE and AMED were searched until June 2017.
Randomised controlled trials (RCTs) concerning natural or treatment-induced menopause, investigating mindfulness or (cognitive-)behaviour-based therapy were selected. Main outcomes were frequency of hot flushes, hot flush bother experienced, other menopausal symptoms and sexual functioning.
DATA COLLECTION AND ANALYSIS:
Study selection and data extraction were performed by two independent researchers. A meta-analysis was performed to calculate the standardised mean difference (SMD).
Twelve RCTs were included. Short-term (<20 weeks) effects of psychological interventions in comparison to no treatment or control were observed for hot flush bother (SMD -0.63, 95% CI -0.80 to -0.46, P < 0.001, I2 = 0%) and menopausal symptoms (SMD -0.34, 95% CI -0.52 to -0.15, P < 0.001, I2 = 0%). Medium-term (≥20 weeks) effects were observed for hot flush bother (SMD -0.49, 95% CI -0.80 to -0.19, P = 0.002, I2 = 63%). In the subgroup treatment-induced menopause, consisting of exclusively breast cancer populations, as well as in the subgroup natural menopause, hot flush bother was reduced by psychological interventions. Too few studies reported on sexual functioning to perform a meta-analysis.
Psychological interventions reduced hot flush bother in the short and medium-term and menopausal symptoms in the short-term. These results are especially relevant for breast cancer survivors in whom HRT is contraindicated. There was a lack of studies reporting on the influence on sexual functioning.
Summary: This NIHR-funded RCT found no evidence that mindfulness-based cognitive therapy was better than continuing antidepressant drugs in reducing depression relapse or recurrence for people at the highest risk of depression. There was also no significant difference in cost. When interpreted alongside the broader evidence for mindfulness-based cognitive therapy and the need for patient choice, the findings suggest an alternative for those patients wishing to consider an alternative to maintenance anti-depressants, and reinforce NICE guidance. However, service limitations may be a barrier to implementation.
Commentary: There is considerable concern about increasing long-term antidepressant use. GPs prescribe antidepressants to 11% of adults, and perhaps half could stop without relapsing, but need help. Kuyken and colleagues’ MBCT helped 70% of participants stop antidepressants, without increasing relapse, so this is an important study. The therapy is intensive however and the skills required in short supply. Group treatment could be provided through the IAPT programme, but many services are already stretched. The study was limited to patients in equipoise over psychological versus antidepressant treatment, which may not apply to many fearful of relapse, and many will prefer individual rather than group treatment. Professor Tony Kendrick, Professor of Primary Care in Medicine, University of Southampton
Objective: we performed the first systematic review with meta-analyses of the existing studies that examined mindfulness-based Baduanjin exercise for its therapeutic effects for individuals with musculoskeletal pain or insomnia. Methods: Both English- (PubMed, Web of Science, Elsevier, and Google Scholar) and Chinese-language (CNKI and Wangfang) electronic databases were used to search relevant articles. We used a modified PEDro scale to evaluate risk of bias across studies selected. All eligible RCTS were considered for meta-analysis. The standardized mean difference was calculated for the pooled effects to determine the magnitude of the Baduanjin intervention effect. For the moderator analysis, we performed subgroup meta-analysis for categorical variables and meta-regression for continuous variables. Results: The aggregated result has shown a significant benefit in favour of Baduanjin at alleviating musculoskeletal pain (SMD = −0.88, 95% CI −1.02 to −0.74, p < 0.001, I2 = 10.29%) and improving overall sleep quality (SMD = −0.48, 95% CI −0.95 to −0.01, p = 004, I2 = 84.42%).
Conclusions: Mindfulness-based Baduanjin exercise may be effective for alleviating musculoskeletal pain and improving overall sleep quality in people with chronic illness. Large, well-designed RCTs are needed to confirm these findings.
Growing evidence has suggested that mindfulness-based interventions (MBIs) could have beneficial effects on the acute phase of depression and on the prevention of depressive relapse or recurrence. Despite growing clinical interest, the effects of MBIs on brain functioning in patients with MDD remain unclear. The aim of this systematic review was to assess the changes in brain functioning associated with MBIs in patients with MDD. A systematic search was conducted, and of the 56 articles found, 8 were eligible. MBIs have modulatory effects on several brain regions implicated in the pathophysiology of MDD, such as the prefrontal cortex, the basal ganglia, the anterior and posterior cingulate cortices, and the parietal cortex. These regions have been implicated in self-awareness, attention and emotion regulation. Some of these findings were consistent with the effects of MBIs observed in healthy subjects and patients with other psychiatric disorders, especially enhanced activity in the frontal and subcortical regions related to the improved somatosensory awareness. Further studies are needed to elucidate the mechanisms of MBIs in MDD
This NIHR-funded RCT found no evidence that mindfulness-based cognitive therapy was better than continuing antidepressant drugs in reducing depression relapse or recurrence for people at the highest risk of depression. There was also no significant difference in cost. When interpreted alongside the broader evidence for mindfulness-based cognitive therapy and the need for patient choice, the findings suggest an alternative for those patients wishing to consider an alternative to maintenance anti-depressants, and reinforce NICE guidance. However, service limitations may be a barrier to implementation.
Mindfulness meditation has become a mainstream technique in the toolkit of psychologists, but its efficacy in non-clinical settings is unclear. In our recent study published in BMC Psychology and registered in the ISRCTN registry, we carefully designed a methodologically robust study to test the effectiveness of mindfulness meditation on critical thinking.
In summary, there have been many unsupported and unchallenged claims regarding the supposed benefits of mindfulness practice, as it is taught in Western psychology, and a big industry has been built on the shaky foundation of these claims. We have demonstrated that it is possible to identify these claims and apply rigorous research methods to determine whether they are supported or not. Mindfulness research must continue to use randomized control trials, double blinding, and objective measurements of adherence and outcomes of the intervention for claims regarding mindfulness practice to be taken seriously.