Last week, Kirsten Lawson blogged about mindfulness-based stress reduction as a treatment for breast cancer.  We have featured a number of blogs on mindfulness in the last couple of years, including a piece about the use of Mindfulness-based cognitive therapy (MBCT).

MBCT is recommended by NICE to prevent relapse in people who have already experienced three or more previous episodes of depression. It is not recommended by NICE for Social Anxiety disorder.

MBCT centres around mindfulness based meditation, which is designed to allow the individual to inhabit the moment more fully. The architects of MBCT describe the “emotional quicksand” we get drawn in to by memories and negative thought spirals. Mindfulness enables individuals to gain distance between themselves and such thoughts, by observing these thoughts without judgment and in the knowledge that they are transient and will pass. During MBCT individuals are taught about mindfulness and taken through exercises that help to develop their mindfulness, with the intention that the practice of mindfulness becomes incorporated in to your daily life.

This meta-analysis was conducted by researchers based in Canada and the US and looked at the effectiveness of Mindfulness Based Therapy (MBT) across a wide range of physical and mental health conditions.

Methods

The authors combined the results of 209 studies (including 12,145 participants) retrieved via highly sensitive searches of PubMed and PsycINFO. A random-effects model was used to combine the results due to the heterogeneity of the included studies.

Results

They found a large effect size in the following conditions:

• Depression:
  • pre-post studies (Hedge’s g=0.66, 95% confidence interval 0.50-0.82)
  • waitlist controlled studies (g=0.53, 0.32 to 0.73)
• Anxiety:
  • pre-post studies (g=0.72, 0.58 to 0.86),
  • waitlist controlled studies (g=1.00, 0.78 to 1.22)
• Psychological disorders:
  • pre-post studies (g=0.57, 0.48 to 0.69),
  • waitlist controlled studies (g=0.70, 0.48 to 0.92)

A moderate effect size for:

• Pain:
  • waitlist controlled studies (g=0.38, 0.20 to 0.57)
• Cancer:
  • pre-post studies (g=0.38, 0.28 to 0.50),
  • waitlist controlled studies (g=0.42, 0.33 to 0.51)
• Physical/medical condition:
  • pre-post studies (g=0.43, 0.35 to 0.51),
  • waitlist controlled studies (g=0.40, 0.33 to 0.48)

A small effect size

• Pain:
  • pre-post studies (g=0.28, -0.01 to 0.57)

Overall, MBT compared favourably with treatment as usual (g=0.44, 0.34 to 0.54) and other psychological treatments (g=0.22, 0.12 to 0.33), a moderate effect size was shown when comparing MBT with both treatment as usual and other psychological treatments (g=0.33, 0.26 to 0.41).

The effect sizes for different types of MBT varied, but all of them demonstrated a moderate to large effect.

Conclusions

The authors concluded:

MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.

MBT was shown to be effective particularly in anxiety and depression, with the treatment effect continuing at follow-up and studies reporting lower drop-out rates than similar CBT studies, suggesting a good adherence to MBT treatment. However, MBT was not shown to be more effective than traditional CBT so further research is required before it will be taken up more widely.

The review showed variable effect sizes for different types of MBT, suggesting that refinement of treatment protocols would help to establish a clearer picture of effectiveness. For example mindfulness based cognitive therapy is recommended by NICE for recurrent depression and they include a specification for what they define as MBCT (p.35).

The authors also highlight that only 45% of studies actually measured “mindfulness”, this could be seen to undermine the results, as they could have been caused by confounders such as the placebo effect of receiving any treatment. However, in studies where mindfulness was reported participants were shown to be more mindful by the end of the study. Therefore it would be helpful for future meta-analyses quantifying the effectiveness of MBT if such outcomes were consistently measured and reported in the literature.

Links

Khoury B, Lecomte T, Fortin G, Masse M, Therien P, Bouchard V, Chapleau MA, Paquin K, Hofmann SG. Mindfulness-based therapy: A comprehensive meta-analysis. Clin Psychol Rev. 2013 Aug;33(6):763-71. doi: 10.1016/j.cpr.2013.05.005. Epub 2013 Jun 7. [PubMed abstract]

Depression: The treatment and management of depression in adults (CG90) (PDF). NICE clinical guideline 90, 2009.

‘Do not do’ recommendation details (from Social anxiety disorder, CG159). NICE clinical guideline 159, 2013.

Mindfulness. Mental Health Foundation website, last accessed 9 Oct 2013.

Williams, M. and Penman, D. (2011) Mindfulness: A practical guide to finding peace in a frantic world. Piatkus: London. See www.franticworld.com