Mindfulness and physical disease: a concise review

Highlights

• Many of today’s most common, costly, and chronic diseases are stress-related.

• Mindfulness, as both a dispositional trait and as a skill-based training, can reduce patient-reported symptoms of stress in physical disease.

• There is little good quality evidence that mindfulness-based interventions impact objective biomarkers of disease severity or progression.

• Adequate empirical support exists to integrate mindfulness with conventional medical care for many stress-related chronic diseases.

• Studies should clarify if mindfulness impacts objective disease measures, generalizes to diverse populations, and is effective in non-academic health settings.

Many of today’s most common, chronic, and costly diseases—from high blood pressure, to chronic pain—are related to stress. Mindfulness, considered a state, a trait, and a training, might help treat or prevent stress-related physical symptoms. A concise review of current scientific evidence shows that both higher levels of trait mindfulness as well as mindfulness training are associated with better psychological well-being, coping, and quality of life. Effects on objective measures of disease, however, are often non-significant or await replication. Larger trials with active control groups, clear diagnostic criteria, objective outcome measures, and longer-term follow-up are needed to generate better quality evidence. Yet, many studies do support integrating mindfulness into health care as part of self-care and disease management.

Introduction

Many of the most common physical diseases in modern society co-occur with mental health conditions, and both can be caused or exacerbated by stress [1]. Although some stress helps individuals respond adaptively to threats in their environment (‘fight or flight’), chronic stress can cause ‘wear and tear’ such that 60–80% of visits to primary care physicians are attributed to stress-related symptoms [2]. Effects of stress on health are further reflected by magnified health care utilization and costs for stress-related chronic diseases [3], as well as by poorer disease outcomes and decreased quality of life (QoL). For many people, experiencing a stress-related disease breeds additional stressors, including physical and psychiatric symptoms, time, travel and monetary obligations related to health care, uncertainty of the future, shifting self-perceptions, the need to make difficult and emotion-laden decisions, and heightened awareness of one’s mortality. If stress cannot be avoided, then it must be managed to reduce the risk of developing stress-related medical symptoms or exacerbating existing illness.

Mindfulness and physical disease

Mindfulness is a promising approach to coping with chronic stress, with significant implications for promoting mind-body health and wellness, irrespective of disease state. The popularity of mindfulness-based interventions (MBIs) has recently surged, given considerable evidence that mindfulness training can decrease subjective measures of stress and that stress reduction effects endure over time [4, 5, 6, 7], and the rising reports of stress and stress-related disease across the globe [8]. A common definition of mindfulness is an awareness of one’s present experience, with acceptance [9]. In theory, the ability to mindfully observe one’s present-moment experience with clarity and equanimity enables more effective appraisals of stressors, which, in turn, facilitates conscious, healthy decisions, and prevents automatic, unhealthy, habitual reactions. Taken together, the core principles and practices of mindfulness can promote self-regulation that may ultimately ‘buffer’ against biological processes and behaviors that contribute to stress-related disease [10].