Introduction
Method
Protocol
Search Strategy
Eligibility Criteria
Search Outcome
Quality Appraisal
Results
Description of Included Studies
Study and method | Participants | Recruitment | Intervention/conditions | Measures utilised | Key findings |
---|---|---|---|---|---|
Bondolfi et al. (2010) RCT
Country: Switzerland | 60 randomised, 43 females; 17 males MBCT + TAU median age = 46 years TAU median age = 49 years | History of major depressive disorder ≥ 3 episodes In remission and not taking medication |
MBCT + TAU: 8 weekly × 2 h sessions, French translation MBCT manual utilised 4 MBCT booster sessions provided over 3 months follow-up
TAU: seek treatment as normal |
Outcome: SCID | Time to relapse was significantly longer for MBCT + TAU compared to TAU alone |
Cash et al. (2015) RCT
Country: USA | 91 randomised, all female 18 years+ | Diagnosis of fibromyalgia Females Available to attend weekly groups |
MBSR: 8 weekly × 2.5 h sessions
Wait-list control: offered the MBSR programme following study |
Outcome: BDI CTQ PSS SSQ FSI FIQ | MBSR significantly reduced perceived stress, sleep disturbance and symptom severity, gains maintained at follow-up MBSR did not significantly alter pain, physical functioning or cortisol |
Crane et al. (2014) RCT
Country: UK | 274 randomised, 198 females; 76 males Mean age of sample = 43 years, range 18–68 years | History of major depressive disorder ≥ 3 episodes Remission for the previous 8 weeks Informed consent from primary care physicians |
MBCT: 8 weekly × 2 h session and 2 follow-up sessions at 6 weeks and 6 months post-treatment
Cognitive Psychological Education (CPE): 8 weekly × 2 h session and 2 follow-up sessions provided at 6 weeks and 6 months post-treatment
TAU: seek treatment as normal |
Outcome: SCID CTQ HAMD
Process: MBI-TAC | See home-practice findings |
Day et al. (2016) Secondary analysis of a RCT
Country: USA | 36 randomised, 32 females, 4 males Mean age of total sample = 41.7 years | 19+ years old ≥ 3 pain days per month due to a primary headache pain If using medication, must have begun ≥ 4 weeks before baseline assessment |
MBCT: 8 weekly × 2 h session and 2 follow-up sessions at 6 weeks and 6 months post-treatment, continued medical treatment as usual
Delayed treatment (DT): medical treatment as usual, then completed MBCT |
Outcome: CSQ WAI-SF BPI CPEG
Process: MBCT-AAQS | Therapists’ adherence and quality were both significant predictors of post-treatment client satisfaction Baseline pain intensity was positively associated with pre-treatment expectations, motivations and working alliance |
Davidson et al. (2003) RCT
Country: USA | 41 randomised, 29 females, 12 males Average age of sample = 36 years, range = 23–56 years | Employees of Biotechnological Corporation in Madison, Wisconsin Right-handed |
MBSR: 8 weekly × 2.5–3 h sessions, 7 h silent retreat
Wait-list control: offered the MBSR programme following the study |
Outcome: PANAS STAI | Meditation can produce increases in relative left-sided anterior activation that are associated with reductions in anxiety and negative affect and increases in positive affect |
Dimidjian et al. (2016) Pilot RCT
Country: USA | 86 randomised MBCT-PD mean age = 31 years TAU mean age = 29 years | Pregnant adult women up to 32 weeks gestation History of major depressive disorder Available to attend weekly groups |
MBCT-PD: adapted MBCT for peri-natal depression, 8 weekly × 2 h sessions, 1 monthly follow-up class
TAU: free to continue or initiate mental health care |
Outcome: SCID SCID-II CSQ LIFE EPDS | Significantly lower rates of relapse and depressive symptoms through 6 months post-partum in MBCT-PD compared to TAU MBCT-PD for at-risk pregnant women was acceptable based on rates of attendance and at-home-practice assignments |
Gross et al. (2011) Pilot RCT
Country: USA | 30 randomised, 22 females, 8 males MBSR median age = 47 years PCT median age = 53.50 years | Diagnosis of primary insomnia Not taking sleep medication Adults English speaking |
MBSR: 8 weekly × 2.5 h sessions and a day-long retreat (6 h)
Pharmacotherapy (PCT): 3 mg of eszopiclone nightly for 8 weeks and as needed for 3 months follow-up Plus 10 min presentation on sleep hygiene |
Outcome: ISI PSQI DBAS-16 SSES STAI CES-D SF-12
Other: sleep diary | MBSR achieved reductions in insomnia symptoms and improvements in sleep quality comparable to PCT Higher treatment satisfaction in MBSR compared to PCT |
Johns et al. (2015) Pilot RCT
Country: USA | 35 randomised, 33 females, 2 males MBSR-CRF mean age = 58.80 years Wait-list control mean age = 55.70 years | Diagnosis of cancer and clinically significant cancer-related fatigue (CRF) for 8 weeks 18+ years old |
MBSR-CRF: 7 weekly × 2 h sessions and brief psycho-education on CRF, adapted MBSR for cancer-related fatigue
Wait-list control: offered the MBSR programme following the study |
Outcome: FSI SF-36 SDS PHQ-9 ISI PHQGADS | MBSR demonstrated significantly greater improvements in fatigue interference than controls and significant improvements in depression and sleep disturbance, improvements in symptoms maintained at 6-month follow-up MBSR proved acceptable to fatigued cancer survivors |
King et al. (2013) Pilot non-randomised controlled trial
Country: USA | 37 participants MBCT mean age = 60.10 years TAU mean age = 58.30 years | Long-term >10 years PTSD or PTSD in partial remission All experienced combat-related traumas from military services |
MBCT: adapted for combat-related PTSD, 8 weekly × 2 h sessions
TAU: 8 × 1 h sessions of
Psychoed: PTSD psycho-education and skills and
IRT: 6 × 1.5 h sessions, of imagery rehearsal therapy |
Outcome: PDS PTCI | MBCT proved an acceptable intervention for PTSD symptoms evidenced by engagement in programme and resulted in significant improvement in PTSD symptoms pre- vs post-MBCT compared to TAU and clinically meaningful improvement in PTSD symptom severity and cognitions |
MacCoon et al. (2012) RCT
Country: USA | 63 randomised, 47 females, 16 males MBSR mean age = 44.50 years HEP mean age = 47.50 years | 18–65 years Right-handed No previous experience of meditation English speaking In good general health |
MBSR: 8 weekly × 2.5 h sessions, 7 h/day retreat
Health Enhancement Programme (HEP): 8 weekly × 2.5 h sessions, 7 hr day retreat, programme to match MBSR, activities valid active therapeutic ingredients but no mindfulness |
Outcome: SCL-90-R MSC | Significant improvements for general distress, anxiety, hostility and medical symptoms but no differences between interventions, MBSR pain rating decrease compared to HEP HEP is an active control condition for MBCT |
Perich et al. (2013) RCT
Country: Australia | 95 participants randomised, 62 females, 33 males No information on age provided | Diagnosis of bipolar I or II disorder, experienced 1+ episode over the past 18 months and lifetime of 3+ episodes Symptoms controlled on a mood stabiliser 18+ years of age, English speaking |
MBCT: 8 weekly sessions, duration of each session not given. Followed Segal et al. (2002) protocol
TAU: treatment as usual Both conditions received weekly psycho-educational material on bipolar disorder |
Outcome: DASS STAI YMRS MADRS CIDI SCID
Process: MAAS TMS | See home-practice findings |
Speca et al. (2000) RCT
Country: Canada | 90 randomised, 73 females, 17 males Mean age of sample = 51 years, age range = 27–75 years | Diagnosis of cancer at any time point were eligible to participate |
MBSR: 7 weekly × 1.5 h sessions, adapted version of Kabat-Zinn MBSR programme
Wait-list control: offered the MBSR programme following the study |
Outcome: POMS SOSI | MBSR effectively reduced mood disturbance, fatigue and a broad spectrum of stress-related symptoms |
Wells et al. (2014) Pilot RCT
Country: USA | 19 randomised, 17 females, 2 males MBSR mean age = 45.90 years TAU mean age = 45.20 years | Diagnosis of migraine, ≥ 1 year history of migraines Available to attend weekly sessions 18+ years old English speaking |
MBSR: 8 weekly × 2 h sessions plus 1-day (6 h) retreat. Utilised Kabat-Zinn protocol
TAU: continue with care as usual and asked not to start a yoga or meditation during study. Offered MBSR following the study |
Outcome: HIT-6 MIDAS MSQ PHQ-9 STAI PSS-10 HMSES
Process: FFMQ | MBSR is safe and feasible for adults with migraines Secondary outcomes demonstrated that MBSR had a beneficial effect on headache duration, disability, self-efficacy and mindfulness |
Whitebird et al. (2012) RCT
Country: USA | 78 randomised, 69 females, 9 males MBSR mean age = 56.40 years CCES mean age = 57.20 years | Self-identified as primary caregiver of family member with dementia 21+ years old English speaking |
MBSR: 8 weekly × 2.5 h sessions, 5-h day retreat
Community Caregiver Education Support (CCES): 8 weekly × 2.5 h sessions, 5-h retreat day. Education on issues affecting family caregivers and group social and emotional support |
Outcome: PSS CES-D STAI SF-12 MBCBS MOSSSS | MBSR is a feasible and acceptable intervention for dementia caregivers, MBSR improved overall mental health, reduced stress and decreased depression at post-intervention compared to CCES Both interventions improved caregiver mental health, anxiety, social support and burden |
Methodological Quality
Study | Sample (10) | Allocation (16) | Assessment (32) | Control groups (16) | Analysis (15) | Active treatment (11) | Total (100) |
---|---|---|---|---|---|---|---|
Perich et al. (2013) | 10 | 16 | 26 | 6 | 15 | 11 | 84 |
Bondolfi et al. (2010) | 10 | 16 | 26 | 6 | 15 | 8 | 81 |
Crane et al. (2014) | 10 | 16 | 6 | 16 | 9 | 11 | 68 |
Dimidjian et al. (2016) | 7 | 10 | 16 | 6 | 15 | 11 | 65 |
MacCoon et al. (2012) | 5 | 16 | 16 | 10 | 15 | 0 | 62 |
Gross et al. (2011) | 10 | 16 | 6 | 10 | 9 | 3 | 54 |
Whitebird et al. (2012) | 10 | 13 | 6 | 10 | 15 | 0 | 54 |
Day et al. (2016) | 5 | 13 | 6 | 6 | 15 | 8 | 53 |
Cash et al. (2015) | 10 | 16 | 6 | 0 | 15 | 3 | 50 |
King et al. (2013) | 2 | 0 | 6 | 16 | 15 | 8 | 47 |
Speca et al. (2000) | 7 | 13 | 6 | 0 | 15 | 6 | 47 |
Wells et al. (2014) | 2 | 10 | 6 | 6 | 15 | 6 | 45 |
Johns et al. (2015) | 2 | 13 | 6 | 0 | 9 | 3 | 33 |
Davidson et al. (2003) | 2 | 10 | 6 | 0 | 9 | 3 | 30 |
Home-Practice Characteristics
Study | Guidance for home-practice | Resources given to participants | Measurement of home-practice | Total reported practice | Proportion of recommended practice achieved | Home-practice findings |
---|---|---|---|---|---|---|
Bondolfi et al. (2010) | Frequency of practice not specified | 2 CDs with recordings of body scan, sitting meditation, mindful movement and 3-min breathing space | Retrospective ad hoc self-report questionnaire |
% practice once per week: Body scan = 65.4% Sitting meditation = 88% 3-min breathing = 91.7% Informal practice = 76% | Could not be calculated | Amount of home-practice did not significantly differ between those who relapsed and those who did not (Fisher’s exact test, N.S.) Following treatment the frequency of informal home-practice remained unchanged over 14 months but longer formal meditation practice decreased over time |
Cash et al. (2015) | 45 min × 6 days a week, practice of body scan, sitting meditation, yoga positions | Workbook and audio-tapes of mindfulness exercises | Self-report weekly log of home-practice and qualitative assessment of how much practice completing at follow-up | Reported practice 4.8 times per week at 2-month follow-up | Could not be calculated | Greater home-practice at follow-up was associated with reduced pain (R
2 = 0.42; p < 0.01, partial r = −0.45) and symptom severity of fibromyalgia (R
2 = 0.24; p < 0.05, partial r = −0.40) |
Crane et al. (2014) | 40 min × 6 days a week, both formal and informal practices required | CD of formal mindfulness exercises | Self-report weekly diary of home-practice | Reported formal practices on average 3.36 days per week, average duration was 21.31 min. Mean no. of units of informal practice was 80.44 over treatment | 26.51% | A significant positive association between mean daily duration of formal home-practice and outcome in MBCT was found. Those who practiced on an average of 3 or more days per week were approximately half as likely to relapse to depression over 12 months of follow-up as those who practiced less frequently [B = −0.03, SE = 0.013, Wald (1) = 5.51, p = 0.018, HR = 0.97, Cl = 0.947 to 0.995] No association between amount of informal home-practice and time to relapse was found [B = −0.002 (SE = 0.002), Wald 1.74, p = 0.19, HR = 1.00, Cl = 0.99 to 1.00] |
Day et al. (2016) | 45 min × 6 days a week, practice | No information noted | Self-report daily meditation practice diary (online administration) | Reported a mean total of 21.69 h of practice throughout MBCT programme | 60.25% | In-session engagement significantly positively predicted client attendance (β = 0.454; R
2 = 0.207; F
1,19 = 4.945; p = 0.038; power = 0.6) and time spent in at-home meditation practice throughout treatment (β = 0.482; R
2 = 0.232; F
1, 19 = 5.749; p = 0.027; power = 0.7). Fidelity ratings were not associated with amount of home-practice (p > 0.05) |
Davidson et al. (2003) | Assigned formal and informal practices 1 h × 6 days a week | Guided audio-tapes to guide mindfulness practices | Self-report daily log of the frequency, number of minutes and techniques of formal meditation practice | Reported mean practice on 2.48 days out of 6 and mean practice 16.19 min per time after intervention, after 4 month follow-up reported mean practice on 1.70 days out of 6 and mean practice 14.21 min per time | 14.87% | There were no significant associations between the measures of practice and brain activity or biological or self-report measures |
Dimidjian et al. (2016) | Specific practices assigned for 6 days each week but amount of time not specifically reported | Audio-files to guide mindfulness practices and a DVD to guide yoga practice | Self-report weekly log of no. of times and type of home-practice | 67% provided practice data, on average practicing 30 out of the 42 assigned days, with a higher total frequency of informal practice than formal practice | Could not be calculated | None reported |
Gross et al. (2011) | 45 min of meditation × 6 days a week for 8 weeks and 20 min daily for 3 months follow-up | Audio-files of recorded meditations and handouts of assignments | Tracked electronically using a pocket size logger which participants turned on every time they began a meditation | 17 patients reported practice data mean 23.7 min per day during intervention and 16 participants reported 21.8 min per day during follow-up | 61.44% | Reductions in DBAS-16 and activity limitation due to insomnia scores were significantly predicted by home-practice during intervention period (Spearman’s rho correlations = 0.62 and 0.71, ps < 0.02) |
Johns et al. (2015) | 20 min practice of body scan, sitting meditation and yoga, no specific guidance reported on number of days per week to practice | Audio-recordings of guided meditations. Participants received $5 for each weekly log submitted | Self-report weekly log of home-practice minutes per day and type of practice | 16/18 submitted practice logs every week, average 35 min practice per day during programme, 6 month follow-up 20 min formal practice on 2 days and informal practice on 3.8 days per week | 45.37% | None reported |
King et al. (2013) | 15–20 min of formal and informal practice 5 days a week, guidance on informal practice given | Received audio-files of formal mindfulness exercises | Self-report weekly log of home-practice minutes per day and what recordings they had listened to | Reported on average 102.3 min of formal practice per week and 12.2 additional minutes of informal practice on days practice was reported | 37.88% | None reported |
MacCoon et al. (2012) | 45 min practice 6 days a week, no guidance on what exercises to practice reported | None reported | Self-report weekly log of minutes and sessions of informal home-practice during the MBSR programme and for the 4 month follow-up period | Average 1849 min of practice reported (44 min over 6 days), average 4394 min of practice reported during 4 month follow-up period (25 min 6 days a week) | 85.6% | Home-practice was not related to change in outcome measures for pain or psychological distress (R
2s ≤ 0.06, p > 0.05) |
Perich et al. (2013) | Formal practice for 5 weeks of programme was 40 min body scan or sitting meditation with CD and 2 weeks without aid of CD for 30–40 min | Received audio-files of formal mindfulness exercises | Self-report weekly log of daily practice. Recorded whether they had engaged in practicing particular exercises, did not measure time spent practicing | 67% provided practice data, mean number of days engaged in at least 1 meditation practice per day was 26.4 days (range 5–44 days) during MBCT programme. 13 noted to continue practice at 12-month follow-up | Could not be calculated | The number of prior bipolar episodes was negatively correlated with number of days practicing [r(23) = −0.512, p = 0.013]. Number of days practicing was not significantly correlated with any of the post-treatment symptoms scores A greater no. of days practicing during the MBCT programme was negatively correlated with depression scores at 12-month follow-up [r(16) = −0.559, p = 0.024] Evidence to suggest that practice was associated with improvements in depression and anxiety symptoms if a minimum of 3 days a week practice was completed during MBCT programme |
Speca et al. (2000) | Specific weekly guidance on what exercises to practice reported but no information on the duration of practice or how many days a week to practice was stated | Received workbook and audio-tape of guided meditation | Self-report record form of duration of participant’s daily meditation practice | Average total daily practice MBSR group during programme was 32 min | 82.96% | Number of minutes spent engaging in home-practice significantly predicted POMS change scores [F(2, 43) = 3.94, p < 0.03] and accounted for 15.5% of the variance in mood improvement. Number of minutes of practice significantly predicted changes in total mood disturbance [r(81) = 2.73, p < 0.01] |
Wells et al. (2014) | 45 min per day, 5 days a week | Given guided audio-recordings to follow during practice | Self-report daily logs of home-practice | Daily meditation average 34 ± 11 min, range 16–50 min per day | 88.14% | None reported |
Whitebird et al. (2012) | No specific guidance reported | Given CDs and written material of home-practice | Self-report measure of minutes per day practice in health behaviour calendars | Reported an average of 6.8 sessions of practice per week and averaged 29.4 min per session during the MBSR programme | 74.04% | None reported |
Home-Practice Monitoring
Guidance and Resources for Home-Practice
Amounts of Home-Practice Reported Across Studies
Maintaining Home-Practice Post-Intervention
Amount of Home-Practice and MBSR/MBCT Guidelines
Associations of Home-Practice and Clinical Outcomes
Discussion
Limitations and Recommendations
Formal practice | ||||
---|---|---|---|---|
Day and Date | ✓ Practiced | Practices Completed (Minutes Practicing) | Resources Used | Comments/Barriers to Practice |
Monday Date: | Ex. ✓Yes | Sitting Meditation (20 min) Body Scan (20 min) | Mindfulness CD | |
Tuesday Date: | ||||
Wednesday Date: | ||||
Thursday Date: | ||||
Friday Date: | ||||
Saturday Date: | ||||
Sunday Date: | ||||
Informal practice
| ||||
Day and Date | ✓ Practiced | Minutes Practicing | Activities Completed | Comments/Barriers to Practice |
Monday Date: | Ex. ✓Yes | 20 min | Mindfulness during washing dishes | |
Tuesday Date: | ||||
Wednesday Date: | ||||
Thursday Date: | ||||
Friday Date: | ||||
Saturday Date: | ||||
Sunday Date: |