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The Effects of Mindfulness Meditation on Attention, Executive Control and Working Memory in Healthy Adults: A Meta-analysis of Randomized Controlled Trials

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Ofir Yakobi
Ofir Yakobi
daniel smilek
daniel smilek
daniel smilek
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James Danckert at University of Waterloo
James Danckert
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Abstract

Background Mindfulness based interventions (MBI) are becoming increasingly popular. Given their nature (i.e., training of focused attention and cognitive control), efforts have been made to study their potential benefits to different aspects of cognition, resulting in mixed results. In light of the inconsistent findings, concerns regarding the methodological quality of such studies, and recent surge in randomized controlled trials of mindfulness interventions, we conducted a meta-analysis focused on MBIs effects on attention, working-memory and executive control in healthy adults. Methods We limited the included studies to randomized controlled trials of mindfulness-based interventions in healthy adults, resulting in 27 included studies (N = 1632). Results We found an overall effect of g = 0.2, with significant effects on attention (g = 0.18) and executive control (g = 0.18), but not on working-memory. Moderation analyses showed that the type of control group included in the study or the dosage (total hours of intervention) did not modulate these effects, but the number of in-class sessions did: the more sessions, the stronger the effect. Conclusions MBIs have limited positive effects on attention and executive control in healthy adults. More studies are needed to address how participants’ motivation may account for this effect, and clarify whether the smaller effects we found are due to our focus on healthy adults, or due to overestimation of effect sizes in previous meta-analyses.
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Cognitive Therapy and Research (2021) 45:543–560
https://doi.org/10.1007/s10608-020-10177-2
ORIGINAL ARTICLE
The Effects ofMindfulness Meditation onAttention, Executive
Control andWorking Memory inHealthy Adults: AMeta‑analysis
ofRandomized Controlled Trials
OrYakobi1 · DanielSmilek1· JamesDanckert1
Accepted: 9 November 2020 / Published online: 4 January 2021
© Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Background Mindfulness based interventions (MBI) are becoming increasingly popular. Given their nature (i.e., training
of focused attention and cognitive control), efforts have been made to study their potential benefits to different aspects of
cognition, resulting in mixed results. In light of the inconsistent findings, concerns regarding the methodological quality of
such studies, and recent surge in randomized controlled trials of mindfulness interventions, we conducted a meta-analysis
focused on MBIs effects on attention, working-memory and executive control in healthy adults.
Methods We limited the included studies to randomized controlled trials of mindfulness-based interventions in healthy
adults, resulting in 27 included studies (N = 1632).
Results We found an overall effect of g = 0.2, with significant effects on attention (g = 0.18) and executive control (g = 0.18),
but not on working-memory. Moderation analyses showed that the type of control group included in the study or the dosage
(total hours of intervention) did not modulate these effects, but the number of in-class sessions did: the more sessions, the
stronger the effect.
Conclusions MBIs have limited positive effects on attention and executive control in healthy adults. More studies are needed
to address how participants’ motivation may account for this effect, and clarify whether the smaller effects we found are due
to our focus on healthy adults, or due to overestimation of effect sizes in previous meta-analyses.
Keywords Mindfulness· Attention· Executive function· Working memory· Randomized control trials· Meta-analysis
Introduction
A growing number of mindfulness studies in the last few
years suggests that mindfulness meditation may have numer-
ous benefits. The introduction of mindfulness training into
mainstream science can be traced back to the development
of Mindfulness-Based Stress Reduction (MBSR), a mindful-
ness-based protocol for treating pain, by Kabat-Zinn (1982).
He defined mindfulness as “paying attention in a particular
way: on purpose, in the present moment, and non-judgmen-
tally” (Kabat-Zinn 1994, p. 4), a definition that has since
been widely adopted in the literature. Mindfulness based
interventions (MBI) are common in mental health settings
as stand-alone interventions, and in conjunction with indi-
vidual or group psychotherapies (Goldberg etal. 2018). This
is not surprising considering that MBIs are relatively short,
cost-effective, evidence-based interventions. For example,
studies from the last decade show that MBIs are effective
in reducing stress, anxiety and can improve sleep (Bartlett
etal. 2019; Eberth and Sedlmeier 2012), as well as reducing
blood pressure, heart-rate and other stress markers (Pascoe
etal. 2017).
Mindfulness based therapies, such as MBSR and Mind-
fulness Based Cognitive Therapy (MBCT; Segal etal. 2002),
have been shown to be effective in reducing symptoms of
anxiety and depression (Cillessen etal. 2019; Hofmann etal.
2010), with comparable and even advantageous outcomes
compared with traditional psychological treatments (Khoury
etal. 2013). With the increasing popularity of mindfulness,
its advocates suggested that MBIs could improve well-
being (Bartlett etal. 2019), mental resiliency (e.g., Galante
etal. 2018), and cognition (in a sense—the very purpose of
* Ofir Yakobi
ofiryakobi@gmail.com
1 Department ofPsychology, University ofWaterloo, 200
University Avenue West, Waterloo, ONN2L3G1, Canada
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... By contrast, the conclusion regarding executive control is further supported by another observation in the literature reviewed. Six meta-analyses computed a global composite index for this function, either based on the three executive control subfunctions 29,31,34,35 or without including outcomes pertaining to working memory (which was evaluated only as an independent process) 33,36 . Providing additional evidence for its plasticity, small improvements in executive performance following mindfulness training were observed in all six cases (estimates ranging from g c = 0.14 (0.06, 0.22) to g c = 0.34 (0.16, 0.51)). ...
... Estimates (Hedges' g) of improvement in cognitive performance following mindfulness training in outcomes pertaining to memory (red), attention (yellow) and executive control (blue) across reviewed meta-analyses [29][30][31][32][33][34][35][36] . Positive (statistically significant) and null (non-significant) findings are represented in colour and in grey, respectively. ...
... In addition, all of them accounted for effect size dependencies, typically with multilevel models such as robust variance estimation (instead of using aggregates) [29][30][31][32][33] , an approach that deals with correlated outcomes without sacrificing information by averaging 40 . Finally, half of the meta-analyses followed preregistered protocols 31,32,35,36 . Given that these strategies align with current best practices 41,42 , they should be maintained in future meta-analytic research in this area. ...
An integrative framework for the mechanisms underlying mindfulness-induced cognitive change
Preprint
  • Apr 2025
Mindfulness meditation has drawn increasing attention in psychological research over the past two decades, including growing interest in its potential cognitive benefits. Meta-analytic evidence suggests that mindfulness training might improve cognitive performance, but the mechanisms underlying these benefits have not been fully characterised. In this Perspective, we integrate empirical and theoretical advances in mindfulness research with established knowledge about the mechanisms and limitations of cognitive training. We introduce the capacity-efficiency mindfulness (CEM) framework, which posits that mindfulness training modulates cognitive function by minimizing cognitive-affective interference during task performance, rather than by increasing overall cognitive resources. This framework emphasises the critical role of mind-wandering and negative affect in disrupting efficient cognitive control and outlines key mechanisms by which mindfulness training might mitigate these factors. We review initial evidence in support of the framework, discuss its predictions and suggest future research directions to test them.
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... The effects of mindfulness on working memory are also not consistently reported (for example, (Flook et al., 2024;Lovette et al., 2022). Meta-analysis by Yakobi et al. (2021) reported significant effects of mindfulness interventions on attention and executive control, but no effect on working memory (Yakobi et al., 2021). Similarly, in a metaanalysis conducted with group-based mindfulness interventions, although a very small effect of mindfulness on working memory was observed, the overall results indicated that the impact of mindfulness interventions on executive functions is not particularly strong (Millett et al., 2021a). ...
... The effects of mindfulness on working memory are also not consistently reported (for example, (Flook et al., 2024;Lovette et al., 2022). Meta-analysis by Yakobi et al. (2021) reported significant effects of mindfulness interventions on attention and executive control, but no effect on working memory (Yakobi et al., 2021). Similarly, in a metaanalysis conducted with group-based mindfulness interventions, although a very small effect of mindfulness on working memory was observed, the overall results indicated that the impact of mindfulness interventions on executive functions is not particularly strong (Millett et al., 2021a). ...
... While there is a reasonable volume of research on the effects of mindfulness on working memory, metaanalyses in this area are limited. Most of the existing meta-analyses have examined the effectiveness of mindfulness in non-clinical groups with a focus on assessing the effects of mindfulness on a range of cognitive functions, with working memory being only part of the set (Cásedas et al., 2020;Whitfield et al., 2022;Yakobi et al., 2021). Other approaches have examined the effects of mindfulness on executive functions in individuals over 18 years old, excluding children and adolescents (Chiesa et al., 2011;Im et al., 2021;Millett et al., 2021b). ...
The effects of mindfulness on working memory: a systematic review and meta-analysis
Preprint
Full-text available
  • Mar 2025
Objectives: Mindfulness is a promising health intervention, showing potential effects on cognitive functions like memory. Despite evidence suggesting mindfulness improves working memory, inconsistencies in results and methodologies prevent definitive conclusions. This meta-analysis examines the effects of mindfulness interventions on working memory across clinical and healthy populations, and various age groups. Methods: A systematic search for relevant English and Persian articles was conducted in WOS, Scopus, PsycINFO, and PubMed databases, along with nine meta-analyses up to February 2023. Included studies consisted of randomized controlled trials (RCTs), controlled trials (CTs), and single-group studies. Overall, 29 studies with 2076 participants aged 5-85 years were analyzed. Results: Mindfulness interventions demonstrated a medium effect size on working memory: RCT two-group studies (Hedges g = 0.438, p < 0.001), CT two-group studies (Hedges g = 0.385, p < 0.005), and single-group studies (Hedges g = 0.583, p < 0.001). These findings confirm the effectiveness of mindfulness interventions in improving working memory. Conclusions: Mindfulness interventions exhibit promising effects on working memory. However, further primary research, particularly rigorous RCTs, is needed to better understand their impacts on clinical versus healthy populations and across diverse age groups.
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... Mindfulness meditation is a mental training technique that typically involves the deliberate selection of an attentional focus, often to the breath or bodily sensations, and the constant direction and re-direction of attention to this focus with an attitude of nonjudgemental awareness (Crane et al., 2017;Van Dam et al., 2018). This practice has been associated with enhanced psychological well-being (Goyal et al., 2014;McClintock et al., 2019;Querstret et al., 2020) as well as improved cognitive performance across specific domains (Im et al., 2021;Sumantry & Stewart, 2021;Yakobi et al., 2021). ...
... Two cognitive processes are commonly reported to be improved by mindfulness meditation: attention and executive control (a function which prioritises the processing of stimuli, cognitive processes and responses related to internal goals). Significant mindfulness-related improvements in accuracy (but not reaction time) are commonly reported from tasks that measure these constructs (Im et al., 2021;Sumantry & Stewart, 2021;Verhaeghen, 2021;Yakobi et al., 2021). Theoretical perspectives, supported by some empirical evidence, suggest that enhanced mindful attention may serve as a core mechanism underlying meditation's positive effects on well-being. ...
... Given this possibility, incorporation of a sustained attention task in future research could be useful to better disentangle any such effects. Current research has shown mixed results for the effects of meditation on cognition, with overall small effect sizes reported in meta-analyses (Sumantry & Stewart, 2021;Yakobi et al., 2021). It may be that any cognitive effects related to meditation are dependent on specific circumstances. ...
Neural differences in conflict monitoring and stimulus expectancy processes in experienced meditators are likely driven by enhanced attention
Preprint
Full-text available
  • Dec 2024
Objectives Mindfulness meditation has been linked to enhanced attention and executive function, likely resulting from practice-related effects on neural activity patterns. In this study, we used an event-related potential (ERP) paradigm to examine brain responses related to conflict monitoring and attention in experienced mindfulness meditators to better understand key factors driving meditation-related effects. Methods We measured electroencephalography-derived N2 and P3 ERPs reflecting conflict monitoring and attention processes from 35 meditators and 29 non-meditators across both an easy and a hard Go/Nogo task (50% Nogo and 25% Nogo stimuli, respectively). Results Meditators displayed distinct neural activity patterns compared to non-meditators, with enhanced N2 responses in fronto-midline electrodes following hard Nogo trials ( p FDR = 0.011, np ² = 0.111). The fronto-midline N2 ERP was also larger following Nogo trials than Go trials, in the harder task condition, and was related to correct responses. Meditators also exhibited a more frontally distributed P3 ERP in the easy task compared to the hard task, while non-meditators showed a more frontally distributed P3 ERP in the hard task ( p FDR = 0.015, np ² = 0.079). Conclusions Mindfulness meditation was associated with distinct topographical patterns of neural activity in the attention task, without corresponding increases in global neural activity amplitudes. These meditation-related effects appear to be driven by attention-specific mechanisms, despite the examined neural activity being associated with conflict monitoring and stimulus expectancy. Our findings suggest that the cognitive benefits of meditation may only emerge in tasks that actively engage targeted cognitive processes, such as sustained attention.
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... By contrast, the conclusion regarding executive control is further supported by another observation in the literature reviewed. Six meta-analyses computed a global composite index for this function, either based on the three executive control subfunctions 29,31,34,35 or without including outcomes pertaining to working memory (which was evaluated only as an independent process) 33,36 . Providing additional evidence for its plasticity, small improvements in executive performance following mindfulness training were observed in all six cases (estimates ranging from g c = 0.14 (0.06, 0.22) to g c = 0.34 (0.16, 0.51)). ...
... In addition, all of them accounted for effect size dependencies, typically with multilevel models such as robust variance estimation (instead of using aggregates) [29][30][31][32][33] , an approach that deals with correlated outcomes without sacrificing information by averaging 40 . Finally, half of the meta-analyses followed preregistered protocols 31,32,35,36 . Given that these strategies align with current best practices 41,42 , they should be maintained in future meta-analytic research in this area. ...
... For instance, focused attention meditation has been portrayed as akin to doing repetitions in the gym to strengthen the 'attention muscle' 45 . Similarly, in the scientific literature it is often argued (more or less explicitly) that the benefits of mindfulness on functions such as working memory, executive attention, or sustained attention result from their repeated engagement during meditation 30,32,[34][35][36] . Although this explanation appeals to common sense, it is at odds with current knowledge about the limitations of cognitive training and transfer. ...
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... Since 2016, at least ten meta-analytic studies have examined the effects of mindfulnessbased interventions on WM performance in healthy adults, but the evidence is generally inconclusive. Yakobi et al. (2021), in their meta-analysis of 27 randomized controlled trials examining the efficacy of mindfulness training in healthy adults, found limited improvements in attention and executive functions but no improvement in WM. Likewise, Cásedas et al. (2020), in a meta-analysis of randomized controlled trials examining the efficacy of mindfulness training on adults (including clinical populations), reported a small effect size for WM. ...
... However, their analysis included both clinical and non-clinical populations as well as children and older adults. Furthermore, as training methods have advanced over time, with the introduction of gamification in cognitive training and the study of approaches such as mindfulness training and physical activity training, there have been further meta-analyses (Gathercole et al. 2019;Cásedas et al. 2020;Yakobi et al. 2021) conducted since 2019 that Sala et al. (2019) second-order meta-analysis has not investigated. ...
... An AMSTAR 2 assessment (Shea et al. 2017) evaluated the included studies and determined that the studies by Wilke et al. (2019), Vermeir et al. (2020), and Cásedas et al. (2020) were of high quality and methodologically sound, with transparent methods. The studies by Yakobi et al. (2021), Soveri et al. (2017) and Gathercole et al. (2019) were categorized as moderate quality due to missing critical steps in their meta-analysis, such as incomplete data extraction by two independent authors. The AMSTRAR-2 assessment is included as a supplemental file. ...
Examining Working Memory Training for Healthy Adults—A Second-Order Meta-Analysis
Article
Full-text available
  • Nov 2024
Background: Enhancing working memory performance in cognitively and physically healthy individuals is a popular area of research. The results from a large number of studies have now been summarized in multiple meta-analyses. In these reviews, various training methods have been examined, including mindfulness training, adaptive working memory training, physical activity training, and video game training, to examine whether working memory capacity can be improved. This report aggregated the results of these meta-analyses using second-order meta-analytic approaches to ascertain the extent to which working memory functioning can be enhanced in healthy adults. Methods: A total of six meta-analyses of randomized controlled trials that compared working memory interventions to a control group were included in the analyses. These studies were identified after systematically searching three electronic databases: APA PsycInfo, ERIC and Medline. Collectively, the meta-analyses investigated the effects of cognitive programs, mindfulness, video games and physical activity on working memory. Only meta-analyses undertaken with healthy adults aged between 18 and 55 years were included in the report. Results: The results revealed an average improvement in working memory across the included studies compared to the control groups. The findings indicated a small yet significant enhancement in working memory, with a standardized mean difference of 0.335 (95% CI [0.223; 0.447], p < .001). Further analysis tests for superiority effects between the different working memory training programs revealed no significant differences between intervention effect sizes. Conclusion: Based on the findings, it can be concluded that the working memory capacity of healthy adults can be improved through training. However, the effect size is small, so the utility of this type of training in real-life improvements in cognition may be minimal. The evidence does not indicate that one type of working memory training is superior to another.
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... A partir dos esforços iniciais de Kabat-Zinn, a psicologia e outras áreas do conhecimento como a filosofia, a biologia, a psiquiatria e as neurociências de modo geral, voltaram suas atenções para a meditação (Cahn & Polich, 2006;Calvetti et al., 2021;Chiesa, Calati, & Serretti, 2011;Kabat-Zinn, 2020;Kabat-Zinn et al., 1985;Katyal & Goldin, 2021;Menezes & Dell'Aglio, 2009;Miyashiro et al., 2021;Mosini et al., 2019;Yakobi, Smilek & Danckert, 2021). Nesse sentido, esses pesquisadores concentraram-se principalmente em seus possíveis efeitos terapêuticos, como por exemplo, em estudos a respeito da associação entre intervenções baseadas em mindfulness e atividades cerebrais Com esse objetivo, foram encontradas relações entre a meditação e mudanças biológicas favoráveis ao sono, com impactos benéficos na diminuição da secreção de cortisol (Brand, Holsboer-Trachsler, Naranjo, & Schmidt, 2012). ...
... Nesse sentido, esses pesquisadores concentraram-se principalmente em seus possíveis efeitos terapêuticos, como por exemplo, em estudos a respeito da associação entre intervenções baseadas em mindfulness e atividades cerebrais Com esse objetivo, foram encontradas relações entre a meditação e mudanças biológicas favoráveis ao sono, com impactos benéficos na diminuição da secreção de cortisol (Brand, Holsboer-Trachsler, Naranjo, & Schmidt, 2012). No âmbito neuropsicológico, melhoras nos níveis de atenção e de funcionamento executivo puderam ser observadas (Chiesa et al., 2011;Sumantry & Stewart, 2021;Yakobi et al., 2021). ...
... Desse modo, a meditação, nos seus variados tipos, pode compreender uma série de atividades neurofisiológicas e psicológicas (Brown et al., 2021;Calvetti et al., 2021;Katyal & Goldin, 2021;Miyashiro et al., 2021;Mosini et al., 2019;Yakobi et al., 2021). Estas envolvem, em separado ou de forma conjunta, postura corporal específica, respiração diafragmática regulada, estabelecimento de foco com ou sem utilização de âncoras verbais associadas, autopercepção corporal, entre outros (Cardoso et al., 2004;Menezes & Dell'Aglio, 2009). ...
Uma discussão analítico-comportamental sobre a meditação
Article
  • Nov 2023
Além de mais espaço no meio profissional, o meio acadêmico tem buscado compreender os fatores que englobam a meditação e seus possíveis benefícios, levantando explicações que recorrem principalmente ao mentalismo e à espiritualidade. Nesse sentido, evidenciando a necessidade de um maior debate teórico-prático, o presente estudo buscou discutir os elementos relacionados às práticas meditativas e aos seus efeitos, por meio da análise do comportamento. É possível relacionar a meditação com as capacidades de autodescrição de estímulos privados e públicos relacionados com outros comportamentos e com contextos específicos. Ela pode compreender uma série de atividades neurofisiológicas e psicológicas que envolvem postura corporal específica, respiração diafragmática regulada, estabelecimento de foco, com ou sem utilização de âncoras verbais associadas, e autopercepção corporal para desenvolver abertura e aceitação do momento presente por meio da autorregulação da atenção. A abertura ao momento presente pode relacionar-se a estar em contato com o momento presente, o que significa mudança do foco atencional para o aqui e agora. Este processo pode estar relacionado a um processo anterior de tomada de consciência, que pode ser entendido como uma capacidade de autodescrição do que se faz, de forma privada ou pública, implicando na aquisição de repertórios que discriminam o próprio comportamento. Já a aceitação do momento presente relaciona-se ao assentimento e acolhimento de determinados eventos privados que estão ocorrendo aqui e agora em relação ao contexto, do modo como eles são evocados por diversos outros eventos privados ou públicos, sem a tentativa de modificar sua configuração e/ou frequência. Desta maneira, pretendeu-se contribuir para a compreensão da meditação, por meio da análise de seu funcionamento de forma mais objetiva e contextual.
View
... Similar effects were shown in a meta-analysis examining mindfulness interventions to treat fibromyalgia, chronic fatigue syndrome, and somatization disorders. Small to moderate positive effects compared to wait-list or control groups, have been reported in reducing pain, symptom severity, depression, anxiety, and executive functioning (Han, 2021;Yakobi et al., 2021). One compelling rationale of using structured mindfulness-based treatment programs for chronic pain is that they provide a range of therapeutic skills/tools, which once learned, no longer require the assistance of healthcare providers (primary physician, pain specialists, physical therapists, psychologists, for example), continued use of medications, and/or medical paraphernalia (needed for steroid injections, acupuncture, biofeedback equipment, for example) for symptom alleviation. ...
... Patients were also more accurate when the target images were incongruent opposed to congruent. Our results align with recent meta-analysis on cognition in healthy populations (Yakobi et al., 2021), reporting positive effects from mindfulness on attention and executive control, but no significant effects on working memory. ...
View
... They engaged in more safety compliance and safety participation behaviors, compared to those with low levels of mindfulness (Liang et al., 2022;Zhang & Wu, 2014). Thus, the present results were in the line with literatures that mindfulness intervention would improve the state of attention or executive control (Felver et al., 2017;Yakobi et al., 2021). The commissioning workers with high levels of mindfulness might be sensitive to their poor personal states and adjust their work strategies efficiently in order to ensure the subsequent work performance. ...
Effects of personal states and personality traits on work performance of commissioning workers in nuclear power plants
Article
Full-text available
  • Nov 2024
Objective Although previous research has indicated that human errors represent the primary cause of incidents in nuclear power safety, few studies have investigated the potential impact of psychological factors on the performance of operators. This study makes a pioneering contribution to the field by integrating the effect of personal states and personality traits on work evaluation. Method A total of 101 commissioning workers in nuclear power plants were recruited and monitored for ten consecutive workdays. The research collected their personality traits and personal states which were indexed by cognitive tasks before daily work. The participants rated their work performance after work as the dependent variable. Results The results of the LASSO regression analysis indicated that the perceptual speed, visual selective attention, and executive control before work were significantly correlated with the self-rated work performance. Furthermore, the interaction between personal states and personality traits exhibited moderating effects, with the effect of mindfulness being the most prominent. Conclusion The present study enhanced understanding of how personality traits may moderate the effect of pre-work personal states on daily work performance. It also provided practical insights for the selection and support of commissioning workers, with a particular focus on the role of appropriate personality traits and robust personal states.
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... Mindfulness meditation has found a place among therapeutic settings, where practitioners employ it as a strategy to promote wellbeing [3,4]. Derived from Buddhist and Hindu traditions, mindfulness and Transcendental Meditation are, by far, the most widely researched techniques of contemplative practices [1], with evidence suggesting that its practice can help improve mental health [5,6], attention [7,8], and pain management [1,9]. However, the field of contemplative studies has overwhelmingly used secularised adaptations of meditation practices [1]. ...
Interpersonal and individual effects of an app-based Christian and Islamic heart meditation intervention in healthy adults: protocol of a stratified randomised controlled trial
Article
Full-text available
  • Sep 2024
Background The academic development and widespread adoption of meditation practices for well-being and therapy have predominantly focused on secularised adaptations of Buddhist and Hindu techniques. This study aims to expand the field by investigating Christian and Islamic meditation that emphasize the spiritual significance of the heart through elements of visualisation and recitation. It compares the effects of spiritual heart-centred meditation with mindfulness meditation and a waitlist control, focusing on dimensions of social functioning, psychophysiology, cognition, and mental health. Method This study employs a stratified 3-arm randomised controlled method with mixed-method repeated measures across three assessment time points: before intervention (T1), after an 8-week intervention (T2), and at a 3-month follow up (T3). The three conditions include spiritual meditation (either Christian or Islamic), mindfulness meditation (Mindfulness-Based Stress Reduction – MBSR), and a waitlist. Participants will be stratified into Christian and Muslim samples and randomly allocated to the spiritual meditation, MBSR, or waitlist control conditions. Importantly, participants assigned to the spiritual meditation condition will be matched to the spiritual meditation program corresponding to their religion. The intervention will be administered through a mobile phone app with daily 20-minute guided meditation sessions for eight weeks. Primary outcomes pertain to the domain of interpersonal functioning, focusing on prosociality, forgiveness, empathy, and perspective taking. Secondary outcomes include physiology: pain tolerance, pain intensity, stress reactivity assessed via heart rate (HR) and heart rate variability (HRV), psychophysiological reactivity associated with a forgiveness task as measured through HR and HRV, attention (alerting, orienting, and executive attention networks), and mental health (stress, depression, anxiety, subjective well-being, positive and negative affect). Discussion This trial aims to test the effects of an app-based Christian and Islamic meditation, compared to secular mindfulness and a waitlist, using a randomised controlled trial. If the results yield positive outcomes, this study will support the efficacy of these contemplations, offering practitioners a way to enhance their well-being within their religious framework. Trial registration ClinicalTrials.gov, NCT06136676. Registered on 18 November 2023. https://clinicaltrials.gov/study/NCT06136676.
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Effects of Exercise Training Interventions on Executive Function in Older Adults: A Systematic Review and Meta-Analysis
Article
Full-text available
  • Aug 2020
  • SPORTS MED
Background Chronic exercise training has been shown be to positively associated with executive function (EF) in older adults. However, whether the exercise training effect on EF is affected by moderators including the specific sub-domain of EF, exercise prescription variables, and sample characteristics remains unknown.Objectives This systematic and meta-analytic review of randomized controlled trials (RCTs) investigated the effects of exercise training on EF in older adults and explored potential moderators underlying the effects of exercise training on EF.Methods In accordance with the PRISMA guidelines, the electronic databases MEDLINE (PubMed) and EMBASE (Scopus) were searched from January 2003 to November 2019. All studies identified for inclusion were peer-reviewed and published in English. To be included, studies had to report findings from older (> 55 years old), cognitively normal adults or adults with mild cognitive impairment (MCI) randomized to an exercise training or a control group. The risk of bias in each study was appraised using the Cochrane risk-of-bias tool. Fixed-effects models were used to compare the effects of exercise training and control conditions on EF assessed at baseline and post-intervention. In addition, subgroup analyses were performed for three moderators (i.e., the specific sub-domain of EF, exercise prescription variables, and sample characteristics).ResultsThirty-three RCTs were included. Overall, exercise training was associated with a significant small improvement in EF [Q(106) = 260.09, Hedges’ g = 0.21; p < 0.01]. The EF sub-domain moderator was not significant [Q(2) = 4.33, p > 0.05], showing that the EF improvement in response to exercise is evident for measures of inhibition, updating, and shifting. Regarding exercise prescription variables, results were significantly moderated by frequency of exercise training [Q(1) = 10.86, p < 0.05], revealing that effect sizes (ESs) were larger for moderate frequency (g = 0.31) as compared to low frequency exercise (g = 0.15). The results also showed type of exercise training moderated the ESs [Q(4) = 26.18, p < 0.05], revealing that ESs were largest for other forms of exercise (g = 0.44), followed by Tai Chi and yoga (g = 0.38), resistance exercise (g = 0.22), aerobic exercise (g = 0.14), and combined exercise (g = 0.10). In addition, The results showed moderated length of training the ESs [Q(2) = 16.64, p < 0.05], revealing that ESs were largest for short length (g = 0.32), followed by mid length (g = 0.26) and long length (g = 0.09). No significant difference in effects was observed as a function of exercise intensity [Q(1) = 2.87 p > 0.05] and session time [Q(2) = 0.21, p > 0.05]. Regarding sample characteristics, the results were significantly moderated by age [Q(2) = 20.64, p < 0.05], with significant benefits for young-old (55–65 years old) (g = 0.30) and mid-old (66–75 years old) (g = 0.25), but no effect on EF for old-old (more than 75 years old). The results were also significantly moderated by physical fitness levels [Q(1) = 10.80, p < 0.05], revealing that ESs were larger for sedentary participants (g = 0.33) as compared to physically fit participants (g = 0.16). In addition, results were also significantly moderated by cognitive status [Q(1) = 11.44, p < 0.05], revealing that ESs were larger for participants with cognitively normal (g = 0.26) as compared to those with mild cognitive impairment (g = 0.08). No significant differences in effects were observed as a function of sex [Q(2) = 5.38, p > 0.05].Conclusions Exercise training showed a small beneficial effect on EF in older adults and the magnitude of the effect was different across some moderators.
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Does Mindfulness Meditation Training Enhance Executive Control? A Systematic Review and Meta-Analysis of Randomized Controlled Trials in Adults
Article
Full-text available
  • Feb 2020
  • Mindfulness
Objectives Over the last years, mindfulness meditation has been claimed to be effective in enhancing several cognitive domains, including executive control. However, these claims have been mostly based on findings pertaining to case-control and cross-sectional studies, which are by nature unable to reveal causal relationships. Aiming to address this issue, we set out to conduct the first quantitative assessment of the literature concerning mindfulness meditation as an enhancer for executive control considering only randomized controlled studies. Methods We conducted a systematic review and meta-analysis covering experimental studies testing the effect of mindfulness meditation training on at least one executive control function (working memory, inhibitory control, or cognitive flexibility) in adult samples. Four databases were examined, resulting in the identification of 822 candidate references. After a systematic filtering process, a set of 16 studies was retained for evaluation, of which 13 could be included in a subsequent meta-analysis. Results We found an average effect size of g = 0.34 [0.16, 0.51], indicating a small-to-medium effect of mindfulness meditation training in enhancing executive control. Effect sizes for individual functions were g = 0.42 [0.10, 0.74] for working memory, g = 0.42 [0.20, 0.63] for inhibitory control, and g = 0.09 [−0.13, 0.31] for cognitive flexibility. Funnel plot asymmetry analysis revealed no evidence of publication bias. Conclusions Taken together, our findings provide preliminary and moderate yet positive evidence supporting the enhancing effects of mindfulness meditation on executive control. Shortcomings of included studies and considerations for future empirical and meta-analytical research are discussed.
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Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials
Article
Full-text available
  • Aug 2019
Objective: Mindfulness-based interventions (MBIs) are increasingly used within psycho-oncology. Since the publication of the most recent comprehensive meta-analysis on MBIs in cancer in 2012, the number of published trials has more than doubled. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and -survivors. Methods: Two authors conducted independent literature searches in electronic databases from first available date to October 10th, 2018, selected eligible studies, extracted data for meta-analysis, evaluated risk of bias. Results: 29 independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post-intervention (Hedges's g=0.32; 95%CI:0.22-0.41;p<0.001) and follow-up (g=0.19; 95%CI:0.07-0.30;p<0.002). Statistically significant effects were also found at either post-intervention or follow-up for a range of self-reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p:<0.001 to 0.047). Larger effects of MBIs on psychological distress were found in studies 1) adhering to the original MBI manuals, 2) with younger patients, 3) with passive control conditions, and 4) shorter time to follow-up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post-intervention. Conclusions: MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and -survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.
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Can Mindfulness-Based Training Improve Positive Emotion and Cognitive Ability in Chinese Non-clinical Population? A Pilot Study
Article
Full-text available
  • Jul 2019
Objective Based on eastern philosophy, mindfulness is becoming popular for human being’s mental health and well-being in western countries. In this study, we proposed to explore the effectiveness and potential pathway of mindfulness-based training (MBT) on Chinese Non-clinical higher education students’ cognition and emotion. Methods A paired control design was used. 48 higher education students (24 in MBT group, 24 in control group) were recruited in the study. The MBT group engaged in a 12-week MBT. A package of measurements, including sustained attention tasks (The Continuous Performance Test, CPT), executive function task (Stroop) for cognitive functions, the self-reported mindfulness levels (The Mindful Attention Awareness Scale, MAAS) and emotion (The Profile of Mood States, POMS), were apply for all participants at baseline and every 4 weeks during next 12 weeks. Results There were no differences in baseline demographic variables between two groups. Over the 12-week training, participants assigned to MBT group had a significantly greater reduction in CPT reaction time (Cohen’s d 0.72), significantly greater improvement in positive emotion (Vigor-Activity, VA) (Cohen’s d 1.08) and in MAAS (Cohen’s d 0.49) than those assigned to control group. And, MAAS at 4th week could significantly predict the CPT RT and VA at 8th week in the MBT group. VA at 4th week could significantly predict the CPT RT at 8th week (B = 4.88, t = 2.21, p = 0.034, R² = 0.35). Conclusion This study shows the efficiency of 12-week MBT on Chinese Non-clinical students’ cognition and emotion. Mindfulness training may impact cognition and emotion through the improvement in mindfulness level, and may impact cognition through the improvement in positive emotion.
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The Effects of Different Stages of Mindfulness Meditation Training on Emotion Regulation
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Full-text available
This study examined mood enhancement effects from 4-week focusing attention (FA) meditation and 4-week open monitoring (OM) meditation in an 8-week mindfulness training program designed for ordinary individuals. Forty participants were randomly assigned to a training group or a control group. All participants were asked to perform cognitive tasks and subjective scale tests at three time points (pre-, mid-, and post-tests). Compared with the participants in the control group, the participants in the meditation training group showed significantly decreased anxiety, depression, and rumination scores; significantly increased mindfulness scores; and significantly reduced reaction times (RTs) in the incongruent condition for the Stroop task. The present study demonstrated that 8-week mindfulness meditation training could effectively enhance the level of mindfulness and improve emotional states. Moreover, FA meditation could partially improve individual levels of mindfulness and effectively improve mood, while OM meditation could further improve individual levels of mindfulness and maintain a positive mood.
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Efficacy of Mindfulness-Based Cognitive Training in Surgery: Additional Analysis of the Mindful Surgeon Pilot Randomized Clinical Trial
Article
Full-text available
  • May 2019
Importance Mindfulness meditation training has been shown to be feasible in surgical trainees, but affective, cognitive, and performance benefits seen in other high-stress populations have yet to be evaluated. Objective To explore potential benefits to stress, cognition, and performance in postgraduate year 1 (PGY-1) surgery residents receiving modified mindfulness-based stress reduction (modMBSR). Design, Setting, and Participants This follow-up study is an analysis of the Mindful Surgeon pilot randomized clinical trial of modMBSR (n = 12) vs an active control (n = 9), evaluated at baseline (T1), postintervention (T2), and 1 year (T3), took place at an academic medical center residency training program among PGY-1 surgery residents. Data were collected between June 2016 and June 2017 and analyzed from June 2017 to December 2017. Interventions Weekly 2-hour modMBSR classes and 20 minutes of daily home practice during an 8-week period vs an active control (different content, same structure). Main Outcomes and Measures Preliminary evidence of efficacy was explored, primarily focusing on perceived stress and executive function and secondarily on burnout, depression, motor skill performance, and changes in blood oxygen level–dependent functional neuroimaging during an emotion regulation task. Group mean scores were calculated at T1, T2, and T3 and in linear mixed-effects multivariate analysis. Effect size for analysis of covariance is presented as partial η² with the following cutoff points: small, less than 0.06; medium, 0.06 to 0.14; large, greater than 0.14. Results Postgraduate year 1 surgery residents (N = 21; 8 [38%] women) were randomized to a modMBSR arm (n = 12) or an active control arm (n = 9). Linear mixed-effects modeling revealed differences at T2 and T3 in perceived stress (mean [SD] difference at T2: modMBSR, 1.42 [5.74]; control, 3.44 [6.71]; η² = 0.07; mean [SD] difference at T3: modMBSR, 1.00 [4.18]; control, 1.33 [4.69]; η² = 0.09) and in mindfulness (mean [SD] difference at T2: modMBSR, 3.08 [3.63]; control, 1.56 [4.28]; η² = 0.13; mean [SD] difference at T3: modMBSR, 2.17 [3.66]; control, −0.11 [6.19]; η² = 0.15). Burnout at T2 (mean [SD] difference: modMBSR, 4.50 [9.08]; control, 3.44 [6.71]; η² = 0.01) and T3 (mean [SD] difference: modMBSR, 5.50 [9.96]; control, 5.56 [9.69]; η² = 0.01) showed similar increase in both groups. Working memory increased more at T2 in the modMBSR arm (mean [SD] difference, 0.35 [0.60]) than in the control arm (mean [SD] difference, 0.21 [0.74]; η² = 0.02) and at T3 (modMBSR, 0.68 [0.69]; control, 0.26 [0.58]; η² = 0.20). Cognitive control decreased more in the control arm at T2 (mean [SD] difference at T2: modMBSR, 0.15 [0.40]; control, −0.07 [0.32]; η² = 0.13) and at T3 (mean [SD] difference: modMBSR, 0.07 [0.59]; control, −0.26 [0.53]; η² = 0.16). Mean (SD) circle-cutting time improved more at T2 in the modMBSR arm (−24.08 [63.00] seconds) than in the control arm (−4.22 [112.94] seconds; η² = 0.23) and at T3 in the modMBSR arm (−4.83 [77.94] seconds) than in the control arm (11.67 [145.17] seconds; η2 = 0.13). Blood oxygen level–dependent functional neuroimaging during an emotional regulation task showed unique postintervention activity in the modMBSR arm in areas associated with executive function control (dorsolateral prefrontal cortex) and self-awareness (precuneus). Conclusions and Relevance In this pilot randomized clinical trial, modMBSR in PGY-1 surgery residents showed potential benefits to well-being and executive function, suggesting a powerful role for mindfulness-based cognitive training to support resident well-being and performance, as mandated by the Accreditation Council for Graduate Medical Education. Trial Registration ClinicalTrials.gov identifier: NCT03141190
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Near and Far Transfer in Cognitive Training: A Second-Order Meta-Analysis
Article
Full-text available
  • Apr 2019
Theory building in science requires replication and integration of findings regarding a particular research question. Second-order meta-analysis (i.e., a meta-analysis of meta-analyses) offers a powerful tool for achieving this aim, and we use this technique to illuminate the controversial field of cognitive training. Recent replication attempts and large meta-analytic investigations have shown that the benefits of cognitive-training programs hardly go beyond the trained task and similar tasks. However, it is yet to be established whether the effects differ across cognitive-training programs and populations (children, adults, and older adults). We addressed this issue by using second-order meta-analysis. In Models 1 (k = 99) and 2 (k = 119), we investigated the impact of working-memory training on near-transfer (i.e., memory) and far-transfer (e.g., reasoning, speed, and language) measures, respectively, and whether it is mediated by the type of population. Model 3 (k = 233) extended Model 2 by adding six meta-analyses assessing the far-transfer effects of other cognitive-training programs (video-games, music, chess, and exergames). Model 1 showed that working-memory training does induce near transfer, and that the size of this effect is moderated by the type of population. By contrast, Models 2 and 3 highlighted that far-transfer effects are small or null. Crucially, when placebo effects and publication bias were controlled for, the overall effect size and true variance equaled zero. That is, no impact on far-transfer measures was observed regardless of the type of population and cognitive-training program. The lack of generalization of skills acquired by training is thus an invariant of human cognition.
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Effects of a Mindfulness Meditation App on Subjective Well-Being: Active Randomized Controlled Trial and Experience Sampling Study
Article
  • Jan 2019
BACKGROUND Mindfulness training (MT) includes a variety of contemplative practices aimed at promoting intentional awareness of experience, coupled with attitudes of nonjudgment and curiosity. Following the success of 8-week, manualized group interventions, MT has been implemented in a variety of modalities, including smartphone apps that seek to replicate the success of group interventions. However, although smartphone apps are scalable and accessible to a wider swath of population, their benefits remain largely untested. OBJECTIVE This study aimed to investigate a newly developed MT app called Wildflowers, which was codeveloped with the laboratory for use in mindfulness research. It was hypothesized that 3 weeks of MT through this app would improve subjective well-being, attentional control, and interoceptive integration, albeit with weaker effects than those published in the 8 week, manualized group intervention literature. METHODS Undergraduate students completed 3 weeks of MT with Wildflowers (n=45) or 3 weeks of cognitive training with a game called 2048 (n=41). State training effects were assessed through pre- and postsession ratings of current mood, stress level, and heart rate. Trait training effects were assessed through pre- and postintervention questionnaires canvassing subjective well-being and behavioral task measures of attentional control and interoceptive integration. State and trait training data were analyzed in a multilevel model using emergent latent factors (acceptance, awareness, and openness) to summarize the trait questionnaire battery. RESULTS Analyses revealed both state and trait effects specific to MT; participants engaging in MT demonstrated improved mood (r=.14) and a reduction of stress (r=-.13) immediately after each training session compared with before the training session and decreased postsession stress over 3 weeks (r=-.08). In addition, MT relative to cognitive training resulted in greater improvements in attentional control (r=-.24). Interestingly, both groups demonstrated increased subjective ratings of awareness (r=.28) and acceptance (r=.23) from pre- to postintervention, with greater changes in acceptance for the MT group trending (r=.21). CONCLUSIONS MT, using a smartphone app, may provide immediate effects on mood and stress while also providing long-term benefits for attentional control. Although further investigation is warranted, there is evidence that with continued usage, MT via a smartphone app may provide long-term benefits in changing how one relates to their inner and outer experiences. TRIAL REGISTRATION ClinicalTrials.gov NCT03783793; https://clinicaltrials.gov/ct2/show/NCT03783793 (Archived by WebCite at http://www.webcitation.org/75EF2ehst).
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Mindfulness induction and cognition: A systematic review and meta-analysis
Article
  • Sep 2020
Mindfulness meditation might improve a variety of cognitive processes, but the available evidence remains fragmented. This preregistered meta-analysis (PROSPERO-CRD42018100320) aimed to provide insight into this hypothesis by assessing the effects of brief mindful attention induction on cognition. Articles were retrieved from Pubmed, PsycInfo and Web of Science up until August 1, 2018. A total of 34 studies were included. The outcomes were categorized into four cognitive domains: attentional functioning, memory, executive functioning and higher-order function. A small effect was found across all cognitive domains (Hedges’ g = 0.18, 95% IC = 0.07–0.29). Separated analyses for each cognitive domain revealed an effect only in higher-order cognitive functions (k = 10, Hedges’ g = 0.35, 95% IC = 0.20–0.50). Results suggest that mindfulness induction improves cognitive performance in tasks involving complex higher-order functions. There was no evidence of publication bias, but studies generally presented many methodological flaws.
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RoB 2: A revised tool for assessing risk of bias in randomised trials
Article
  • Aug 2019
Assessment of risk of bias is regarded as an essential component of a systematic review on the effects of an intervention. The most commonly used tool for randomised trials is the Cochrane risk-of-bias tool. We updated the tool to respond to developments in understanding how bias arises in randomised trials, and to address user feedback on and limitations of the original tool.
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