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. 2014 Mar;174(3):357-68.

doi: 10.1001/jamainternmed.2013.13018.

Meditation programs for psychological stress and well-being: a systematic review and meta-assay

Sonal Singh ¹ , Erica Grand S Sibinga ² , Neda F Gould ³ , Anastasia Rowland-Seymour ¹ , Ritu Sharma ⁴ , Zackary Berger ¹ , Dana Sleicher ³ , David D Maron ^four , Hasan K Shihab ^iv , Padmini D Ranasinghe ¹ , Shauna Linn ⁴ , Shonali Saha ² , Eric B Bass ⁵ , Jennifer A Haythornthwaite ³

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• PMID: 24395196
• PMCID: PMC4142584
• DOI: 10.1001/jamainternmed.2013.13018

Costless PMC commodity

Review

Meditation programs for psychological stress and well-being: a systematic review and meta-analysis

Madhav Goyal  et al. JAMA Intern Med. 2014 Mar .

Gratuitous PMC article

Abstruse

Importance: Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation.

Objective: To determine the efficacy of meditation programs in improving stress-related outcomes (feet, depression, stress/distress, positive mood, mental wellness-related quality of life, attending, substance utilize, eating habits, sleep, pain, and weight) in diverse adult clinical populations.

Evidence review: We identified randomized clinical trials with agile controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two contained reviewers screened citations and extracted data. We graded the forcefulness of bear witness using 4 domains (adventure of bias, precision, directness, and consistency) and adamant the magnitude and management of result by calculating the relative difference between groups in change from baseline. When possible, nosotros conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% conviction intervals.

Findings: Later reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at three-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-vi months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low testify of no issue or insufficient bear witness of whatever effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no prove that meditation programs were improve than any agile treatment (ie, drugs, exercise, and other behavioral therapies).

Conclusions and relevance: Clinicians should be aware that meditation programs can event in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should exist prepared to talk with their patients about the office that a meditation program could have in addressing psychological stress. Stronger study designs are needed to decide the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.

Figures

Effigy 1

Figure 1A: Summary across measurement domains of comparisons of meditation programs with non-specific active controls Figure 1B. Summary across measurement domains of comparisons of meditation programs with specific active controls

1. CSM = Clinically Standardized Meditation, a mantra meditation plan; TM=Transcendental Meditation, a mantra meditation plan

2. CHF = Congestive Heart Failure; CAD = Coronary Artery Affliction

3. PO = Number of trials in which this was a primary event for the trial; PA = Chief Analysis; MA = Meta-analysis; N = sample size

4. Direction based on relative difference in change analysis:

   ↑ indicates that the meditation group improved relative to the control grouping (with a relative divergence more often than not greater than or equal to 5 percent across trials).

   ↓ indicates the meditation group worsened relative to the control group (with a relative departure mostly greater than or equal to v pct across trials).

   Ø indicates a goose egg result (with a relative deviation generally less than 5 per centum across trials).

   ↑↓ indicates inconsistent findings (some trials reported improvement with meditation [relative to command] while others showed no improvement or comeback in the control group [relative to meditation]).

5. Magnitude based on relative difference in the change score: This is a relative pct difference, using the baseline mean in the meditation group as the denominator. For example, if the meditation group improves from a 10 to xix on a mental health scale and the command group improves from 11 to 16 on the same scale, the relative difference betwixt groups in the change score is: (((nineteen-x)-(sixteen-11))/10)x100=xl%. The interpretation is that there is a 40% relative improvement on the mental health calibration in the meditation grouping compared with the command group. Improvement in all scales is indicated in the positive management. A positive relative percent difference means that the score improved more in the intervention group than in the control group

Meta-analysis figure on far right shows Cohen's d with the 95% CI * Summary effect size not shown due to business concern for publication bias for this outcome **Negative affect combines the outcomes of anxiety, depression, stress/distress, and is thus duplicative of those outcomes *** Nosotros did not perform meta-analysis on this issue since it would duplicate the anxiety meta-analysis for mantra. Feet and depression are indirect measures of negative touch on, and therefore resulted in a lower strength of evidence than for the effect of mantra on anxiety.

Figure one

Effigy 1A: Summary across measurement domains of comparisons of meditation programs with not-specific active controls Effigy 1B. Summary across measurement domains of comparisons of meditation programs with specific active controls

1. CSM = Clinically Standardized Meditation, a mantra meditation program; TM=Transcendental Meditation, a mantra meditation program

2. CHF = Congestive Heart Failure; CAD = Coronary Artery Affliction

3. PO = Number of trials in which this was a master result for the trial; PA = Master Assay; MA = Meta-analysis; Due north = sample size

4. Direction based on relative difference in alter assay:

   ↑ indicates that the meditation group improved relative to the control group (with a relative difference generally greater than or equal to 5 percent across trials).

   ↓ indicates the meditation group worsened relative to the control group (with a relative deviation generally greater than or equal to 5 pct beyond trials).

   Ø indicates a nix effect (with a relative divergence more often than not less than 5 percent across trials).

   ↑↓ indicates inconsistent findings (some trials reported comeback with meditation [relative to command] while others showed no improvement or improvement in the control group [relative to meditation]).

5. Magnitude based on relative difference in the alter score: This is a relative percentage difference, using the baseline mean in the meditation group as the denominator. For example, if the meditation group improves from a 10 to 19 on a mental health scale and the control group improves from 11 to 16 on the same scale, the relative difference between groups in the change score is: (((nineteen-10)-(sixteen-11))/10)x100=twoscore%. The interpretation is that there is a 40% relative improvement on the mental health calibration in the meditation grouping compared with the control group. Improvement in all scales is indicated in the positive direction. A positive relative per centum difference ways that the score improved more in the intervention group than in the control group

Meta-analysis figure on far right shows Cohen's d with the 95% CI * Summary event size not shown due to concern for publication bias for this effect **Negative touch combines the outcomes of anxiety, depression, stress/distress, and is thus duplicative of those outcomes *** We did not perform meta-analysis on this outcome since information technology would duplicate the feet meta-assay for mantra. Anxiety and low are indirect measures of negative affect, and therefore resulted in a lower strength of evidence than for the outcome of mantra on anxiety.

Figure 2. Summary of the literature search

* Full exceeds the number in the exclusion box considering reviewers were allowed to mark more than 1 reason for exclusion

Annotate in

• Moving toward evidence-based complementary care.

  Goroll AH. Goroll AH. JAMA Intern Med. 2014 Mar;174(3):368-9. doi: x.1001/jamainternmed.2013.12995. JAMA Intern Med. 2014. PMID: 24395188 No abstract available.

• Meditation intervention reviews.

  Rutledge T, Mills P, Schneider R. Rutledge T, et al. JAMA Intern Med. 2014 Jul;174(7):1193. doi: x.1001/jamainternmed.2014.1419. JAMA Intern Med. 2014. PMID: 25003876 No abstract available.

• Meditation intervention reviews.

  Walach H, Schmidt S, Esch T. Walach H, et al. JAMA Intern Med. 2014 Jul;174(7):1193-4. doi: 10.1001/jamainternmed.2014.1422. JAMA Intern Med. 2014. PMID: 25003877 No abstract available.

• Meditation intervention reviews.

  Loucks EB. Loucks EB. JAMA Intern Med. 2014 Jul;174(7):1194-5. doi: x.1001/jamainternmed.2014.1924. JAMA Intern Med. 2014. PMID: 25003878 Free PMC commodity. No abstract available.

• Meditation intervention reviews--respond.

  Goyal Chiliad, Bass EB, Haythornthwaite JA. Goyal Thou, et al. JAMA Intern Med. 2014 Jul;174(7):1195. doi: 10.1001/jamainternmed.2014.1393. JAMA Intern Med. 2014. PMID: 25003880 No abstruse available.

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