Original articleThe effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis
Introduction
Many chronic somatic diseases are highly prevalent in industrialized countries. About 45% of healthy 40-year-old men and 30% of healthy 40-year-old women, for example, will develop coronary heart disease in later life [1]. It is estimated that 85% of older adults is affected by one or more chronic diseases [2]. In more recent studies that defined chronic pain as pain of >3 months duration, prevalence rates of chronic pain ranged from 10.8–23.7% [3], [4]. For mental disorders, the presence of chronic somatic diseases is a risk factor. An increased risk of developing an anxiety disorder has been found among people with arthritis [5], coronary heart diseases [6]. An increased prevalence of depression has been found for many chronic physical somatic diseases in both cross-sectional and longitudinal studies, e.g., cardiovascular diseases [6], cancer [7], and arthritis [5]. It is estimated that between 20% and 30% of cancer patients will experience depressive symptomatology [8], [9].
Mindfulness-based stress reduction (MBSR) is a treatment for psychological distress, depressive symptoms, and anxiety for people with chronic disease that is rapidly growing in popularity in the United States. Developed by Kabat-Zinn [10], [11], the MBSR program consists of 8–10 sessions for groups of up to 30 participants. Central here is the practice of mindfulness. Mindfulness is the skill to non-judgmentally observe emotions, sensations, or cognitions. Mindfulness is moment-to-moment awareness and is trained through meditation exercises that have been adapted from Buddhist traditions. Besides these meditation skills, yoga exercises and psycho-education are also part of the program. Whereas MBSR was originally developed for people with chronic pain, it was later also applied to people with chronic diseases such as cancer [12], fibromyalgia [13], and heart failure [14]. Apart from MBSR, mindfulness is also an important component of other treatments such as acceptance and commitment therapy [15], dialectic behavioral treatment [16], and cognitive therapy [17].
Two meta-analyses have so far studied the effects of MBSR on mental health [18], [19]. Grossman et al. [18] conducted a meta-analysis of 20 controlled and uncontrolled studies on the effects of MBSR on physical and mental health of medical and non-medical samples. They found an effect size of d=0.54 for controlled studies on mental health. No effect sizes for specific symptomatology (depression, anxiety) were reported. Baer [19] included both controlled and uncontrolled studies focusing on populations with somatic diseases, clinical populations, and nonclinical populations. Effect sizes of d=0.70 for anxiety (eight studies) and d=0.84 for depression (five studies) across the different populations were reported. Average effect sizes at posttreatment across medical and psychological outcomes of d=0.37 were found for patients with chronic pain and d=0.55 for patients with other somatic disorders. Both meta-analyses included only two published, controlled studies on the effects of mindfulness on mental health in populations with somatic diseases. No effect sizes for depression and anxiety in these populations were calculated. Qualities of studies that might moderate the effects on mental health were not systematically analyzed.
On the basis of the fact that, in recent years, many more controlled studies on MBSR in somatic medical populations have been published, we decided to conduct a new meta-analysis on the effects of MBSR in people with chronic somatic diseases. The objective was to analyze the overall effects of MBSR on psychological distress, depression, and anxiety.
Section snippets
Selection of studies
Studies were selected through a search of two computerized databases of the literature: Medline and PsychINFO Medline (1966–2008) yielded 5512 results using mindfulness as keyword and randomized controlled trial as limitation. PsychINFO (1960–2008) yielded 1114 results, using mindfulness as keyword. The abstracts of potentially eligible studies were read and those that reported effects of MBSR on populations with chronic somatic diseases were retrieved and studied, as were the primary studies
Selected studies
Fifty-three studies were found. Eight studies met the inclusion criteria [12], [14], [26], [27], [28], [29], [30], [31]. Twenty-six studies were excluded because the effects of mindfulness had been studied on nonmedical populations. Fifteen studies did not use a control group or a randomization procedure, and four studies were excluded because insufficient data were available for calculating effect sizes. Characteristics of the selected studies are presented in Table 1. There was a large
Discussion
We examined the effects of mindfulness-based stress reduction on depression, anxiety, and psychological distress in people with chronic somatic diseases by conducting a meta-analysis of eight randomized controlled trials. An overall effect on depression of 0.26 was found. This effect size is considerably lower than the effect size for depression (0.86) found by Baer [19]. Baer, however, conducted a meta-analysis across different populations and also included non-controlled studies. The finding
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