Improve Mental Health with Mindfulness
By John M. de Castro, Ph.D.
“Mindfulness is recommended as a treatment for people with mental ill-health as well as those who want to improve their mental health and wellbeing.” – Mental Health Foundation
Over the last several decades, research and anecdotal experiences have accumulated an impressive evidential case that the development of mindfulness has positive benefits for the individual’s mental, physical, and spiritual life. Mindfulness appears to be beneficial both for healthy people and for people suffering from a myriad of mental and physical illnesses. It appears to be beneficial across ages, from children to the elderly. And it appears to be beneficial across genders, personalities, race, and ethnicity.
The breadth and depth of benefits is unprecedented. There is no other treatment or practice that has been shown to come anyway near the range of mindfulness’ positive benefits. Mindfulness appears to work well in clinical settings. But does it work well when mindfulness is trained in groups in community settings. It makes sense to step back and summarize what has been learned.
In today’s Research News article “Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799763/ ) Galante and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials of the effectiveness of mindfulness-based programs to improve mental health. They identified 136 trials including a total of 11,605 participants of the effectiveness of community-based group mindfulness programs.
They report that in comparison to no treatment controls, mindfulness-based programs produced significant improvements in anxiety, depression, psychological distress, and mental well-being. In comparison to non-therapeutic active controls mindfulness-based programs produced significant improvements in depression, and mental well-being. Finally, mindfulness-based programs did not appear to improve mental health to a greater extent that other therapeutic treatments. They further found that mindfulness-based programs appeared to work best for high-risk participants or those with subclinical levels of mental disorders.
There appears to be extensive research findings that suggest that group mindfulness-based programs in non-clinical, community, are as effective in improving mental health as other therapies. In particular they appear to decrease symptoms of anxiety, depression, and psychological distress and increase mental well-being. But, these programs do not appear to further improve mental health in people who already have excellent mental health. This suggests that mindfulness-based community programs should be implemented to improve the mental health of at-risk individuals or those who have metal health issues.
So, improve mental health with mindfulness.
“simple changes in lifestyle can lead to improved mental health and wellbeing. Mindfulness is one such practice—with strong research supporting its usefulness for those suffering from anxiety, depression, or even just daily stress.” – U Minnesota
CMCS – Center for Mindfulness and Contemplative Studies
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Galante, J., Friedrich, C., Dawson, A. F., Modrego-Alarcón, M., Gebbing, P., Delgado-Suárez, I., Gupta, R., Dean, L., Dalgleish, T., White, I. R., & Jones, P. B. (2021). Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials. PLoS medicine, 18(1), e1003481. https://doi.org/10.1371/journal.pmed.1003481
There is an urgent need for mental health promotion in nonclinical settings. Mindfulness–based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions.
Methods and findings
Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in–person, expert–defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk–of–Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well–being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta–regression and sensitivity analyses were prespecified. Pairwise random–effects multivariate meta–analyses and prediction intervals (PIs) were calculated.
A total of 11,605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = −0.56; 95% confidence interval (CI) −0.80 to −0.33; p–value < 0.001; 95% PI −1.19 to 0.06), depression (14 trials; SMD = −0.53; 95% CI −0.72 to −0.34; p–value < 0.001; 95% PI −1.14 to 0.07), distress (27 trials; SMD = −0.45; 95% CI −0.58 to −0.31; p–value < 0.001; 95% PI −1.04 to 0.14), and well–being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p–value = 0.003; 95% PI −0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = −0.46; 95% CI −0.81 to −0.10; p–value = 0.012, 95% PI −1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well–being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs’ superiority. Only effects on distress remained when higher–risk trials were excluded. USA–based trials reported smaller effects. MBPs targeted at higher–risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials.
Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.
Why was this study done?
Mindfulness courses to increase well–being and reduce stress have become very popular; most are in community settings.
Many randomised controlled trials (RCTs) tested whether mindfulness courses show benefit, but results are varied and, to our knowledge, there are no reviews combining the data from these studies to show an overall effect.
What did the researchers do and find?
Worldwide, we identified 136 RCTs on mindfulness training for mental health promotion in community settings. We reviewed them all, assessed their quality, and calculated their combined effects.
We showed that, compared with doing nothing, mindfulness reduces anxiety, depression, and stress, and increases well–being, but we cannot be sure that this will happen in every community setting.
In these RCTs, mindfulness is neither better nor worse than other feel–good practices such as physical exercise, and RCTs in this field tend to be of poor quality, so we cannot be sure that our combined results represent the true effects.
What do these findings mean?
Mindfulness courses in the community need to be implemented with care, because we cannot assume that they work for everyone, everywhere.
We need good quality collaborative research to find out which types of communities benefit from the different types of mindfulness courses available.
The courses that work best may be those aimed at people who are most stressed or in stressful situations.