Evidence

There is a wealth of evidence now regarding the positive effects mindfulness practice can have. Much of the research that has been done has focussed on physical of psychological ill-health. However, mindfulness is increasingly being used other settings such as business, sport, and education, to increase performance and ‘wellbeing’.  So mindfulness is now recognised as being more than a ‘remedy’ for challenging experiences and conditions.  In due course I shall therefore rewrite the following summary of the evidence-base for the use of mindfulness to reflect this wider application. This page provides references to some of the studies and clinical trials which have examined the effectiveness of Mindfulness-based Cognitive Therapy (MBCT) and Mindfulness-based Stress Reduction (MBSR). As a non-medical practitioner I would not want to make or infer any claim that my courses can serve as a treatment for any medical condition. This page is simply intended as a general summary of published findings, for background information.

Mindfulness in the Workplace: Evidence


 

 

[1]  ‘Making the Business Case for Mindfulness in the Workplace’ Juliet Adams, Mindfulnet.org, February 2013

[2]  Halliwell E (2010) Mindfulness Report. Mental Health Foundation.. Available to buy from http://www.bemindful.co.uk/mbct/evidence

[3]   Sources compiled from ‘Making the Business Case for Mindfulness in the Workplace’ Juliet Adams, Mindfulnet.org, February 2013

[4]  Theresa M. Glomb, Michelle K. Duffy, Joyce E. Bono, Tao Yang (2011), Mindfulness at

Work, in Aparna Joshi, Hui Liao, Joseph J. Martocchio (ed.) Research in Personnel and Human Resources Management (Research in Personnel and Human Resources Management, Volume 30), Emerald Group Publishing Limited, pp.115‐157 http://www.emeraldinsight.com/books.htm?chapterid=1938232

[5]  Hozel, Carmody, Lazar et al (2011) Mindfulness practice leads to increases in regional brain grey matter density. Psychiatry Resource 2011 Jan 30;191(1):36‐43. Epub 2010 Nov 10.
“The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking” (abstract).

[6]  Dane, E. (2010). Paying attention to mindfulness and its effects on task performance in the workplace. Journal of Management.

[7]  Hozel, Carmody, Lazar et al (2011) Mindfulness practice leads to increases in regional brain grey matter density. Psychiatry Resource 2011 2011 Jan 30;191(1):36‐43. Epub 2010 Nov 10.

[8]  Bishop, M. L., Shapiro, S., Carlson, L., Anderson, N., Carmody, J., Segal, Z., Abbey, S.,Speca, M., Velting, D. and Devins, G. (2004) Mindfulness: A Proposed Operational Definition.

[9]  Gardner, F.L. and Moore, Z.E. (2007) The psychology of enhancing human performance: The Mindfulness‐Acceptance‐Commitment (MAC) approach. New York: Springer.

[10]  Wells, A. (2006) Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal of Rational‐Emotive & Cognitive‐Behaviour Therapy, 23 (4), 337‐335.

[11]  Hozel, Carmody, Lazar et al (2011) Mindfulness practice leads to increases in regional brain grey matter density. Psychiatry Resource 2011 2011 Jan 30;191(1):36‐43. Epub 2010 Nov 10.

[12]  Theresa M. Glomb, Michelle K. Duffy, Joyce E. Bono and Tao Yang,(2011): Mindfulness at work. Personnel and Human Resources Management, Volume 30, 115–157

[13]  Kirk, Downar & Montague (2011) Interception drives increased rational decision‐making in mediators’ playing the ultimatum game.

[14]  Zeidan, F., Johnson, S.K.., Diamond, B.J. David, Z., & Goolkasian, P. (2010). Mindfulness meditation improves cognition: Evidence of brief mental training. Consciousness and Cognition, 19(2), 597‐605.

“After four sessions of . . . meditation training . . . brief meditation training reduced fatigue, anxiety, and increased mindfulness. Moreover, brief mindfulness training significantly improved visuo-spatial processing, working memory, and executive functioning. Our findings suggest that 4 days of meditation training can enhance the ability to sustain attention; benefits that have previously been reported with long-term meditators”. (Abstract)

[15]  Beckman, H. B., Wendland, M., Mooney, C., Krasner, M. S., et al. (2012). The impact of a program in mindful communication on primary care physicians. Academic Medicine, 87(6), 1‐5. http://www.ncbi.nlm.nih.gov/pubmed/22534599

[16]  Li‐Chuan Chu (2009): The benefits of meditation vis‐à‐vis emotional intelligence, perceived stress and negative mental health Li‐Chuan Chu Article first published online: 29, SEP 2009

Summary of the findings from a report commissioned by the The Mental Health Foundation.

There have been a wealth of trials examining the effect of mindfulness programs, such as MBCT and MBSR, on depression, anxiety and stress. The evidence linking MBCT with reduced rates of relapse into depression is so strong in fact that the National Institute of Clinical Excellence (NICE) recommends MBCT for people who have had two or more depressive episodes.

                 MBCT

                 MBSR

  •             MBCT is more effective than maintenance doses of antidepressants in preventing a relapse in depression.
  •             Three-quarters of people taking an MBCT course alongside antidepressants were able to come off their medication within 15 months.
  •             MBCT can also reduce the severity of symptoms for people who are experiencing an episode of depression.
  •             MBCT has been shown to reduce insomnia in people with anxiety disorders.
  •             People who are more mindful have greater self-esteem and feel less neurotic.
  •             Meditation-based practices like mindfulness reduce people’s dependence on alcohol, caffeine, prescription medication and illegal drugs.

Source: the bemindful website

  •         A 70 per cent reduction in anxiety
  •         Fewer visits to your GP
  •         An ongoing reduction in anxiety three years after taking an MBSR course
  •         An increase in disease-fighting antibodies, suggesting improvements to the immune system
  •         Longer and better quality sleep, with fewer sleep disturbances
  •         A reduction in negative feelings like anger, tension and depression
  •         Improvements in physical conditions as varied as psoriasis, fibromyalgia and chronic fatigue syndrome.

Source: the bemindful website

Specific scientific research into the effectiveness of MBCT & MBSR

The following is a summary of some MBCT and MBSR research trials, which I’m posting here for anyone wanting a more specific scientific summary of the clinical evidence. It is crucial to bear in mind that these trials only provide evidence, not cast iron proof.

A  recent ICM survey showed that almost three quarters of doctors now think that all patients would benefit from learning mindfulness meditation skills (1).  MBCT has been shown to be clinically effective in reducing the chance of depressive relapse by nearly 50 percent for people who are prone to recurrent depression but not currently depressed (2) (3) (4) (5) (5a). There is also some recent evidence of its effectiveness in reducing depression in people who are currently depressed (6) (7). Indeed, recent research suggests it may be as effective as antidepressants in preventing depressive relapse (8). There is also evidence that MBCT is clinically effective in treating anxiety (9) (10) (11). One trial also showed that MBCT can reduce specific anxiety and depression associated with stressful life situations such as sitting exams (12).MBCT is an adaptation of the Mindfulness-based Stress Reduction (MBSR) course developed by John Kabat-Zinn, in combination with Cognitive Behaviour Therapy (CBT).

MBSR has been used for over 30 years as a program to help people manage the stress of chronic pain and extreme health conditions (14). MBSR has also been shown to reduce generalised anxiety .(15), and, significantly, it has also been shown to reduce stress in healthy people (16). There have also been studies examining the effect of MBSR on specific medical conditions such as psoriasis  (17) and fibromyalgia (18).MBCT has also now been further adapted as a treatment for Chronic Fatigue Syndrome and preliminary findings have shown it to increase quality of life and provide significant improvements in subjective levels of fatigue for ME/CFS sufferers (19) (20).There is also some evidence that MBCT and MBSR may help reduce insomnia (21) (22). There is even now evidence that mindfulness can improve performance in sport (23). Similarly, a recent study on the value of mindfulness meditation concludes, “These preliminary findings suggest a significantly upwards shift in general levels of satisfaction for individuals who commit to a period of meditation. This is a promising finding in relation to an exploration of the beneficial impact of meditation for the workplace” (24)One study investigating the value of mindfulness for people with health-anxiety (hypochondriasis) concluded that “There were significant improvements in measures of health anxiety, disease-related thoughts, somatic symptoms, and mindfulness at the end of treatment, and these benefits were sustained at 3-month follow-up. Participants evidenced high treatment satisfaction, with no drop-outs or adverse events.” (25)

References

(1)          Halliwell E (2010) Mindfulness Report. Mental Health FoundationAttachment (1) . Available to buy from http://www.bemindful.co.uk/mbct/evidence(2)          The  National Institute For Clinical Excellence (NICE) guidelines (p10) recommend MBCT as a treatment for people who are currently well but have experienced three or more previous episodes of depression- www.nice.org.uk/nicemedia/pdf/CG90NICEguideline.pdf (3)          Teasdale, J. D., Segal, Z. V., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based Cognitive Therapy. Journal of Consulting and Clinical Psychology, 68(4), 615-623.  Attachment (3). “In summary, the main finding was that, in participants with three or more previous episodes of depression . . . an “adequate dose” of MBCT almost halved relapse/recurrence rates over the follow-up period compared with TAU.” (p621) (4)          Ma. S. H., Teasdale, J. D. (2004) Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Journal of Consulting and Clinical Psychology, Vol 72(1), Feb 2004, 31-40. doi: 10.1037/0022-006X.72.1.31. http://www.ncbi.nlm.nih.gov/pubmed/14756612 “Recovered recurrently depressed patients were randomized to treatment as usual (TAU) or TAU plus mindfulness-based cognitive therapy (MBCT). Replicating previous findings, MBCT reduced relapse from 78% to 36% in 55 patients with 3 or more previous episodes.” (Abstract) (4)          Piet J, Hougaard E. (2011) The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: a systematic review and meta-analysis. Clin Psychol Rev. Aug;31(6):1032-40. http://www.ncbi.nlm.nih.gov/pubmed/21802618 “Results of this meta-analysis indicate that MBCT is an effective intervention for relapse prevention in patients with recurrent MDD (Major Depressive Disorder) in remission, at least in case of three or more previous MDD episodes.” (abstract) (5) •       K.A. Godfrin, C. van Heeringen http://dx.doi.org/10.1016/j.brat.2010.04.006,  “The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study”  Behaviour Research and Therapy, Volume 49, Issue 2, February 2011, Page 144 Abstract “At the end of the study period relapse/recurrence was significantly reduced and the time until first relapse increased in the MBCT plus TAU condition in comparison with TAU alone. The MBCT plus TAU group also showed a significant reduction in both short and longer-term depressive mood and better mood states and quality of the life. For patients with a history of at least three depressive episodes who are not acutely depressed, MBCT, added to TAU, may play an important role in the domain of relapse revention in depression.” (5a)  ‘Efficacy of mindfulness-based cognitive therapy in relation to prior history of depression: randomised controlled trial. Nicole Geschwind, et al (2012), British Journal of Psychiatry. “Conclusion: Mindfulness-based cognitive therapy reduces residual depressive symptoms irrespective of the number of previous episodes of major depression.” “The research team found that MBCT significantly reduced people’s residual depressive symptoms, thereby improving their quality of life. On average, the MBCT group experienced a 30-35% reduction in their residual symptoms, compared to 10% in the control group. Importantly, the researchers found no evidence that MBCT had a greater effect on people who had had three or more previous episodes of depression than those who had had only one or two previous episodes, as was found in previous studies.” (6)          Barnhofer T., Crane, C., Hargus E., Amarasinghe, M., Winder, R., Williams, J. M. G. (2009).  Mindfulness-based cognitive therapy as a treatment for chronic depression: A preliminary study. Behaviour Research and Therapy. Volume 47, Issue 5, May 2009, Pages 366–373 Attachment (5) http://www.sciencedirect.com/science/article/pii/S0005796709000333 “Self reported symptoms of depression decreased from severe to mild levels in the MBCT group while there was no significant change in the TAU group. Similarly, numbers of patients meeting full criteria for depression decreased significantly more in the MBCT group than in the TAU group. Although based on a small sample and, therefore, limited in their generalizability, they provide further preliminary evidence that MBCT can be used to successfully reduce current symptoms in patients suffering from a protracted course of the disorder.” (abstract) (7)          Kennya,  M.A. ., Williams  J.M.G., (2007). Treatment-resistant depressed patients show a good response to Mindfulness-based Cognitive Therapy. Behaviour Research and Therapy 45 617–625. “ . . . a clinical audit was conducted to explore the use of MBCT in patients who were currently actively depressed . . . ” (abstract). “The results of this preliminary audit suggest that MBCT . . . appears to be effective in significantly reducing levels of depression, even in those who start with a more severe pattern including suicidal depression” (p623). (8)          Segal ZV, Bieling P, Young T, MacQueen G, Cooke R, Martin L, Bloch R, Levitan RD. (2010). Antidepressant monotherapy vs sequential pharmacotherapy and mindfulness-based cognitive therapy, or placebo, for relapse prophylaxis in recurrent depression.  Archives of Gen Psychiatry. 2010 Dec;67(12):1256-64. http://www.ncbi.nlm.nih.gov/pubmed/21135325 “For depressed patients achieving stable or unstable clinical remission, MBCT offers protection against relapse/recurrence on a par with that of maintenance antidepressant pharmacotherapy.” (Abstract) (9)          Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183. http://www.ncbi.nlm.nih.gov/pubmed/20350028 “CONCLUSIONS: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations.” (Abstract) (10)        Kim B, Lee SH, Kim YW, Choi TK, Yook K, Suh SY, Cho SJ, Yook KH. (2010). Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder.  J Anxiety Disord. Aug;24(6):590-5. http://www.ncbi.nlm.nih.gov/pubmed/20427148 “ MBCT could be effective as an adjunct to pharmacotherapy in patients with panic disorder.” (Abstract) (11)        Semple R. J., Lee J., , Rosa D.,  Miller L., F., (2010). A Randomized Trial of Mindfulness-Based Cognitive Therapy for Children: Promoting Mindful Attention to Enhance Social-Emotional Resiliency in Children.  Journal of Child and Family Studies. Volume 19, Number 2 218-229, DOI: 10.1007/s10826-009-9301-y http://www.springerlink.com/content/h32j085273675w20/ “Significant reductions in anxiety symptoms and behavior problems were found for those children who reported clinically elevated levels of anxiety at pretest (n = 6). Results show that MBCT-C is a promising intervention for attention and behavior problems, and may reduce childhood anxiety symptoms.” (Abstract)
(12)         Kaviani H., Javaheri F., Hatami N., (2011) Mindfulness-based Cognitive Therapy (MBCT) Reduces Depression and Anxiety Induced by Real Stressful Setting in Non-clinical Population.  International Journal of Psychology and Psychological Therapy 2011, 11, 2, pp. 285-296. “The results support the assumption that MBCT techniques and exercises help students not to experience high levels of anxiety, depression, negative automatic thoughts and dysfunctional attitudes during exams period.” (p292) “ The findings provide further evidence that MBCT might be a useful intervention for enhancing well-being in non-clinical populations who are susceptible to experience anxiety and depression in real life situations” (Abstract). (13)        Steven Rosenzweiga s., Greeson, j.m.,Reibel d.k., Green j.s.,Jassere, S. A., Beasleyc D., (2010) Mindfulness-based stress reduction for chronic pain conditions: Variation in treatment outcomes and role of home meditation practiceJournal of Psychosomatic Research 68 (2010) 29–36 (14) J Kabat-Zinn – 1996 – Full catastrophe living: How to cope with stress, pain and illness using mindfulness meditation. Piatkus. (This book documents Kabat- Zinn’s use of MBSR for 30 years with chronic pain patients at the University of massachusetts Medical Centre). (15)        Vøllestad J, Sivertsen B, Nielsen G. H., (2011).  Mindfulness-based stress reduction for patients with anxiety disorders: evaluation in a randomized controlled trial. Behav Res Ther. 2011 Apr;49(4):281-8. Epub 2011 Jan 27. http://www.ncbi.nlm.nih.gov/pubmed/21320700 “ . . . we conclude that MBSR is an effective treatment for anxiety disorders and related symptomatology.” (Abstract) (16)        Chiesa A., Alessandro S., (2009). Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis. Journal of Alternative and Complementary Medicine. May, 15(5): 593-600. doi:10.1089/acm.2008.0495. http://www.ncbi.nlm.nih.gov/pubmed/19432513 “Results: MBSR showed a nonspecific effect on stress reduction in comparison to an inactive control, both in reducing stress and in enhancing spirituality values . . . A direct comparison study between MBSR and standard relaxation training found that both treatments were equally able to reduce stress. Furthermore, MBSR was able to reduce ruminative thinking and trait anxiety, as well as to increase empathy and self-compassion. Conclusions: MBSR is able to reduce stress levels in healthy people”. (Abstract) (17)         Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, Bernhard JD. (2009).  Influence of a Mindfulness Meditation-Based Stress Reduction Intervention on Rates of Skin Clearing in Patients With Moderate to Severe Psoriasis Undergoing Phototherapy (UVB) and Photochemotherapy (PUVA). Psychosom Med. 1998 Sep-Oct;60(5):625-32.  See attachment (16) “Conclusions: A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.” (from the abstract) (18)        Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. (2007).  Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychotherapy and Psychosomatics 76:226-233.  See attachment (15) “CONCLUSIONS: Based upon a quasi-randomized trial and long-term observational follow-up, results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients. (19)        Rimes, K. A. and Wingrove, J. (2011), Mindfulness-Based Cognitive Therapy for People with Chronic Fatigue Syndrome Still Experiencing Excessive Fatigue after Cognitive Behaviour Therapy: A Pilot Randomized Study. Clin. Psychol. Psychother.. doi: 10.1002/cpp.793 http://onlinelibrary.wiley.com/doi/10.1002/cpp.793/abstract “Analysis of covariance controlling for pre-treatment scores indicated that, at post-treatment, MBCT participants reported lower levels of fatigue (the primary clinical outcome) than the waiting-list group. Similarly, there were significant group differences in fatigue at 2-month follow-up, and when the MBCT group was followed up to 6 months post-treatment, these improvements were maintained.” (Abstract). (20)        Surawy, C., Roberts, J.,; Silver, A., (2005). The Effect of Mindfulness Training on Mood and Measures of Fatigue, Activity, and Quality of Life in Patients with Chronic Fatigue Syndrome on a Hospital Waiting List: A Series of Exploratory Studies . Behavioural and Cognitive Psychotherapy, Vol 33(1), Jan 2005, 103-109. doi: 10.1017/S135246580400181X http://psycnet.apa.org/psycinfo/2005-01418-009 “Three exploratory studies evaluated group mindfulness . . . The approaches used were based on Mindfulness Based Stress Reduction, and Mindfulness Based Cognitive Therapy. A second . . .study . . .demonstrated an improvement in quality of life as measured by the Fatigue Impact Scale (FIS). More wide-ranging effects were demonstrated in the final study in which significant improvements in subjective levels of fatigue, anxiety, depression, quality of life and physical functioning were observed following the training programme. These effects were sustained for 3 months. Overall, the findings of the three exploratory studies indicate that MBSR/MBCT has potential for the treatment of patients with CFS.” (abstract). (21)        Gross CR, Kreitzer MJ, Reilly-Spong M, Wall M, Winbush NY, Patterson R, Mahowald M, Cramer-Bornemann M. (2011).   Mindfulness-based stress reduction versus pharmacotherapy for chronic primary insomnia: a randomized controlled clinical trial. Explore (NY). 2011 Mar-Apr;7(2):76-87. http://www.ncbi.nlm.nih.gov/pubmed/21397868 “study provides initial evidence for the efficacy of MBSR as a viable treatment for chronic insomnia as measured by sleep diary, actigraphy, well-validated sleep scales, and measures of remission and clinical recovery.”  (abstract). (22)        Yook K, Lee SH, Ryu M, Kim KH, Choi TK, Suh SY, Kim YW, Kim B, Kim MY, Kim MJ. (2008). Usefulness of Mindfulness-Based Cognitive Therapy for Treating Insomnia in Patients With Anxiety Disorders: A Pilot Study.  Journal of Nervous & Mental Disease:  June 2008 – Volume 196 – Issue 6 – pp 501-503, doi: 10.1097/NMD.0b013e31817762ac, http://www.ncbi.nlm.nih.gov/pubmed/18552629 “These findings suggest that MBCT can be effective at relieving insomnia symptoms by reducing worry associated sleep disturbances in patients with anxiety disorder.” (Abstract) (23) Mindfulness and Acceptance Approachesin Sport Performance. Journal of Clinical Sports Psychology, 2009, 4, 320-333 © 2009 Human Kinetics, Inc. Marjorie Bernier, Emilie Thienot, Romain Codron,and Jean F. Fournier. http://www.academia.edu/712338/Mindfulness_and_acceptance_approaches_in_sport_performance   (24) Doleman, E., Bond, D., Exploring the value of a meditation practice, The Ashridge Journal Mindful leadership:  Spring 2011 http://www.ashridge.org.uk/website/IC.nsf/966EA4406D050D388025784C00544774/$file/MindfulLeadership.pdf
(25) Mindfulness-based cognitive therapy for hypochondriasis, or severe healthanxiety: A pilot study. Elsevier Journal, David A. Lovasa,, Arthur J. Barskya, (2010)

Symptoms of Depression

Depression is characterised by a range of symptoms including:  low mood; hopelessness; self-criticism; mental rumination about problems; feeling tearful and sad; feeling a lack of motivation; not enjoying life; and a range of physical symtoms (see below for more detail).

Psychological symptoms include:
  • continuous low mood or sadness
  • feeling hopeless and helpless
  • having low self-esteem
  • feeling tearful
  • feeling irritable and intolerant of others
  • having no motivation or interest in things
  • finding it difficult to make decisions
  • not getting any enjoyment out of life
  • feeling anxious or worried
Physical symptoms include:
  • Moving or speeking more slowly than usual
  • change in appetite or weight (usually decreased, but sometimes increased)
  • constipation
  • unexplained aches and pains
  • lack of energy or lack of interest in sex
  • changes to your menstrual cycle
  • disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

(source – NHS Choices website)