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Evidence Based Mindfulness. An overview
of Cochrane systematic reviews.
Laura Rubio Rodriguez MD MSc, Miguel Maldonado Fernández MD PhD MSc (Oxford), Jaime López Fernández MD
Introduction: Overviews are powerful tools that help clinicians to be updated with constantly changing evidence. Mindfulness is a form of
meditation that cultivates present moment awareness in a non-judging way. If has a Buddhist origin but has been practiced in the last 40 years
without relation to any religious belief. It has been proposed as a treatment for a variety of ailments.
Objectives: To carry out an overview of systematic reviews of the evidence on mindfulness as a therapeutic tool.
Aims:To summarize the existing evidence on the efficacy of mindfulness.
Methods: We searched for mindfulness Cochrane systematic reviews in the Cochrane Database of Systematic Reviews (Cochrane Library). The
search was updated as of 21st February 2016.
Results: We found 11 Cochrane citations (for fibromyalgia, aggressiveness in intellectually disabled people, mechanical neck disorders,
reducing sedentariness at work, anxiety, somatoform disorders, post-stroke fatigue, stress reduction for women with breast cancer, substance
use disorders, haematological malignancies, and depression in adults and children with traumatic brain injury). Two were excluded because
they were Cochrane review protocols. Two more references were excluded because they did not
The Cochrane reviews showed a lack of conclusive evidence for fibromyalgia, aggressiveness in intellectually disabled people, anxiety
disorders, somatoform disorders and post-stroke fatigue. Mindfulness training induced a non-significant reduction in workplace sitting time.
For chronic neck pain, mindfulness exercises minimally improved function but no global effect was perceived at short term (Table 1).
Conclusions: According to the existing Cochrane reviews, there is a general lack of evidence mindfulness as an effective
treatment. For chronic neck pain, mindfulness exercises minimally improved function. We have detected important areas
where high quality clinical trials are needed.
REFERENCE
Included/
Excluded
Reason for Exclusion
Alice Theadom , Mark Cropley , Helen
E Smith , Valery L Feigin and Kathryn
McPherson
Online Publication Date: April 2015
Included
Afia Ali , Ian Hall , Jessica Blickwedel
and Angela Hassiotis
Online Publication Date: April 2015
Excluded
Intervention was cognitive
-
behavioural interventions, not
mindfulness
Nipun Shrestha , Sharea Ijaz , Katriina
T Kukkonen
-Harjula , Suresh Kumar
and Chukwudi P Nwankwo
Online Publication Date: January 2015
Excluded
Workplace interventions for
reducing sitting at work.
Mindfulness is not the
intervention in this study.
Anita Gross , Theresa M Kay , Jean
-
Philippe Paquin , Samuel Blanchette ,
Patrick Lalonde , Trevor Christie ,
Genevieve Dupont , Nadine Graham ,
Stephen J Burnie , Geoff Gelley ,
Charles H Goldsmith , Mario Forget ,
Jan L Hoving , Gert Brønfort ,
Pasqualina L Santaguida and Cervical
Overview Group
Online Publication Date: January 2015
Included
Thawatchai Krisanaprakornkit ,
Wimonrat Sriraj , Nawanant
Piyavhatkul and Malinee Laopaiboon
Online Publication Date: January 2006
Included
Paul Gertler , Robyn L Tate and Ian D
Cameron
Online Publication Date: December
2015
Included
Andrea Will , Michaela Rancea , Ina
Monsef , Achim Wöckel , Andreas
Engert and Nicole Skoetz
Online Publication Date: February
2015
Excluded
Protocol phase
Susanne Rösner , Reinhard Willutzki
and Aleksandra Zgierska
Online Publication Date: June 2015
Excluded
Protocol phase
Ines Salhofer , Andrea Will , Ina
Monsef and Nicole Skoetz
Online Publication Date: February
2016h
Included
Nikki van Dessel , Madelon den Boeft ,
Johannes C van der Wouden , Maria
Kleinstäuber , Stephanie S Leone ,
Berend Terluin , Mattijs E Numans ,
Henriëtte E van der Horst and Harm
van Marwijk
Online Publication Date: November
2014
Included
Simiao Wu , Mansur A Kutlubaev , Ho
-
Yan Y Chun , Eileen Cowey , Alex
Pollock , Malcolm R Macleod , Martin
Dennis , Elizabeth Keane , Michael
Sharpe and Gillian E Mead
Online Publication Date: July 2015
Included
REFERENCE
DISEASE
Results
Alice
Theadom , Mark Cropley , Helen E Smith ,
Valery L
Feigin and Kathryn McPherson
Online
Publication Date: April 2015
Fibromyalgia
There is insufficient evidence to determine the use of biofeedback,
mindfulness, movement therapies or relaxation based therapies for
adults with fibromyalgia.
Anita
Gross , Theresa M Kay , Jean-Philippe
Paquin
, Samuel Blanchette , Patrick Lalonde ,
Trevor Christie ,
Genevieve Dupont , Nadine
Graham , Stephen J
Burnie , Geoff Gelley ,
Charles H
Goldsmith , Mario Forget , Jan L
Hoving
,
Gert Brønfort , Pasqualina L Santaguida and
Cervical
Overview Group
Online
Publication Date: January 2015
Mechanical neck
disorders
Three of the studies compared mindfulness with enhanced or
structured care. There were no differences in drop
-out rates or
symptom severity.
At the end of treatment, mindfulness did not result in lower levels
of dysfunctional cognitions, emotions, and behaviours, compared
with enhanced care. However, within one year of treatment, these
levels were lower for mindfulness (two studies).
Thawatchai Krisanaprakornkit , Wimonrat Sriraj ,
Nawanant Piyavhatkul and Malinee Laopaiboon
Online Publication Date: January 2006
Anxiety disorders
The small number of studies included in this review do not permit
any conclusions to be drawn on the effectiveness of meditation
therapy for anxiety disorders. Transcendental meditation is
comparable with other kinds of relaxation therapies in reducing
anxiety, and
Kundalini Yoga did not show significant effectiveness in treating
obsessive
-compulsive disorders compared with
Relaxation/Mindfulness Meditation.
Drop out rates appear to be high, and adverse effects of meditation
have not been reported. More trials are needed.
Paul Gertler , Robyn L Tate and Ian D Cameron
Online Publication Date: December 2015
Depression in adult
a children with
traumatic brain
injury
The review did not find compelling evidence in favour of any
intervention. Future studies should focus on participants with a
diagnosed
TBI and include only participants who have a diagnosis of
depression, or who record scores above a clinical cut off on a
depression
measure. There is a need for additional RCTs that include a
comparison between an intervention and a control that replicates
the effect
of the attention given to participants during an active treatment
Ines Salhofer , Andrea Will , Ina Monsef and
Nicole Skoetz
Online Publication Date: February 2016h
Haematological
malignancies
There were not enough data available to determine the
effectiveness of meditation practice on haematologically
-diseased
patients, thus the role of meditation in the treatment of
haematological malignancies remains unclear. More high
-quality
and larger randomised controlled trials are needed to validate
possible positive effects of meditation practice for
haematologically
-diseased patients.
Nikki van Dessel , Madelon den Boeft , Johannes
C van der Wouden , Maria Kleinstäuber ,
Stephanie S Leone , Berend Terluin , Mattijs E
Numans , Henriëtte E van der Horst and Harm
van Marwijk
Online Publication Date: November 2014
Somatoform
disorders and
medically
unexplained
physical symptoms
in adults.
When all psychological therapies included this review were
combined they were superior to usual care or waiting list in terms
of reduction of symptom severity, but effect sizes were small. As a
single treatment, only CBT has been adequately studied to allow
tentative conclusions for practice to be drawn. Compared with
usual care or waiting list conditions, CBT reduced somatic
symptoms, with a small effect and substantial differences in effects
between CBT studies. The effects were durable within and after
one year of follow
-up. Compared with enhanced or structured
care, psychological therapies generally were not more effective for
most of the outcomes. Compared with enhanced care, CBT was not
more effective. The overall quality of evidence contributing to this
review was rated low to moderate.
The number of studies investigating various treatment modalities
(other than CBT) needs to be increased; this is especially relevant
for studies concerning physical therapies. Future studies should
include participants from a variety of age groups; they should also
make efforts to blind outcome assessors and to conduct follow
-up
assessments until at least one year after the end of treatment.
Simiao Wu , Mansur A Kutlubaev , Ho
-Yan Y
Chun , Eileen Cowey , Alex Pollock , Malcolm R
Macleod , Martin Dennis , Elizabeth Keane ,
Michael Sharpe and Gillian E Mead
Online Publication Date: July 2015
Post
-
stroke fatigue
There was insufficient evidence on the efficacy of any intervention
to treat or prevent fatigue after stroke. Trials to date have been
small
and heterogeneous, and some have had a high risk of bias. Some of
the interventions described were feasible in people with stroke,
but
their efficacy should be investigated in RCTs with a more robust
study design and adequate sample sizes.
Corresponding author: Miguel Maldonado Fernández. maldonado2000@gmail.com
