Meditation and Mindfulness: Effectiveness and Safety (original) (raw)

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What are meditation and mindfulness?

Meditation has a history that goes back thousands of years, and many meditative techniques began in Eastern traditions. The term “meditation” refers to a variety of practices that focus on mind and body integration and are used to calm the mind and enhance overall well-being. Some types of meditation involve maintaining mental focus on a particular sensation, such as breathing, a sound, a visual image, or a mantra, which is a repeated word or phrase. Other forms of meditation include the practice of mindfulness, which involves maintaining attention or awareness on the present moment without making judgments.

Programs that teach meditation or mindfulness may combine the practices with other activities. For example, mindfulness-based stress reduction is a program that teaches mindful meditation, but it also includes discussion sessions and other strategies to help people apply what they have learned to stressful experiences. Mindfulness-based cognitive therapy integrates mindfulness practices with aspects of cognitive behavioral therapy.

Are meditation and mindfulness practices safe?

Meditation and mindfulness practices usually are considered to have few risks. However, few studies have examined these practices for potentially harmful effects, so it isn’t possible to make definite statements about safety.

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A 2020 review examined 83 studies (a total of 6,703 participants) and found that 55 of those studies reported negative experiences related to meditation practices. The researchers concluded that about 8 percent of participants had a negative effect from practicing meditation, which is similar to the percentage reported for psychological therapies. The most commonly reported negative effects were anxiety and depression. In an analysis limited to 3 studies (521 participants) of mindfulness-based stress reduction programs, investigators found that the mindfulness practices were not more harmful than receiving no treatment.

How popular are meditation and mindfulness?

According to the National Health Interview Survey, an annual nationally representative survey, the percentage of U.S. adults who practiced meditation more than doubled between 2002 and 2022, from 7.5 to 17.3 percent. Of seven complementary health approaches for which data were collected in the 2022 survey, meditation was the most popular, beating out yoga (used by 15.8 percent of adults), chiropractic care (11.0 percent), massage therapy (10.9 percent), guided imagery/progressive muscle relaxation (6.4 percent), acupuncture (2.2 percent), and naturopathy (1.3 percent).

For children aged 4 to 17 years, data are available for 2017; in that year, 5.4 percent of U.S. children used meditation.

Why do people practice mindfulness meditation?

In a 2012 U.S. survey, 1.9 percent of 34,525 adults reported that they had practiced mindfulness meditation in the past 12 months. Among those responders who practiced mindfulness meditation exclusively, 73 percent reported that they meditated for their general wellness and to prevent diseases, and most of them (approximately 92 percent) reported that they meditated to relax or reduce stress. In more than half of the responses, a desire for better sleep was a reason for practicing mindfulness meditation.

What are the health benefits of meditation and mindfulness?

Meditation and mindfulness practices may have a variety of health benefits and may help people improve the quality of their lives. Recent studies have investigated if meditation or mindfulness helps people manage anxiety, stress, depression, pain, or symptoms related to withdrawal from nicotine, alcohol, or opioids.

Other studies have looked at the effects of meditation or mindfulness on weight control or sleep quality.

However, much of the research on these topics has been preliminary or not scientifically rigorous. Because the studies examined many different types of meditation and mindfulness practices, and the effects of those practices are hard to measure, results from the studies have been difficult to analyze and may have been interpreted too optimistically.

Stress, Anxiety, and Depression

• A 2018 NCCIH-supported analysis of 142 groups of participants with diagnosed psychiatric disorders such as anxiety or depression examined mindfulness meditation approaches compared with no treatment and with established evidence-based treatments such as cognitive behavioral therapy and antidepressant medications. The analysis included more than 12,000 participants, and the researchers found that for treating anxiety and depression, mindfulness-based approaches were better than no treatment at all, and they worked as well as the evidence-based therapies.
• A 2021 analysis of 23 studies (1,815 participants) examined mindfulness-based practices used as treatment for adults with diagnosed anxiety disorders. The studies included in the analysis compared the mindfulness-based interventions (alone or in combination with usual treatments) with other treatments such cognitive behavioral therapy, psychoeducation, and relaxation. The analysis showed mixed results for the short-term effectiveness of the different mindfulness-based approaches. Overall, they were more effective than the usual treatments at reducing the severity of anxiety and depression symptoms, but only some types of mindfulness approaches were as effective as cognitive behavioral therapy. However, these results should be interpreted with caution because the risk of bias for all of the studies was unclear. Also, the few studies that followed up with participants for periods longer than 2 months found no long-term effects of the mindfulness-based practices.
• A 2019 analysis of 23 studies that included a total of 1,373 college and university students looked at the effects of yoga, mindfulness, and meditation practices on symptoms of stress, anxiety, and depression. Although the results showed that all the practices had some effect, most of the studies included in the review were of poor quality and had a high risk of bias.

High Blood Pressure

Few high-quality studies have examined the effects of meditation and mindfulness on blood pressure. According to a 2017 statement from the American Heart Association, the practice of meditation may have a possible benefit, but its specific effects on blood pressure have not been determined.

• A 2020 review of 14 studies (including more than 1,100 participants) examined the effects of mindfulness practices on the blood pressure of people who had health conditions such as hypertension, diabetes, or cancer. The analysis showed that for people with these health conditions, practicing mindfulness-based stress reduction was associated with a significant reduction in blood pressure.

Pain

Studies examining the effects of mindfulness or meditation on acute and chronic pain have produced mixed results.

• A 2020 report by the Agency for Healthcare Research and Quality concluded that mindfulness-based stress reduction was associated with short-term (less than 6 months) improvement in low-back pain but not fibromyalgia pain.
• A 2020 NCCIH-supported analysis of five studies of adults using opioids for acute or chronic pain (with a total of 514 participants) found that meditation practices were strongly associated with pain reduction.
• Acute pain, such as pain from surgery, traumatic injuries, or childbirth, occurs suddenly and lasts only a short time. A 2020 analysis of 19 studies examined the effects of mindfulness-based therapies for acute pain and found no evidence of reduced pain severity. However, the same analysis found some evidence that the therapies could improve a person’s tolerance for pain.
• A 2017 analysis of 30 studies (2,561 participants) found that mindfulness meditation was more effective at decreasing chronic pain than several other forms of treatment. However, the studies examined were of low quality.
• A 2019 comparison of treatments for chronic pain did an overall analysis of 11 studies (697 participants) that evaluated cognitive behavioral therapy, which is the usual psychological intervention for chronic pain; 4 studies (280 participants) that evaluated mindfulness-based stress reduction; and 1 study (341 participants) of both therapies. The comparison found that both approaches were more effective at reducing pain intensity than no treatment, but there was no evidence of any important difference between the two approaches.
• A 2019 review found that mindfulness-based approaches did not reduce the frequency, length, or pain intensity of headaches. However, the authors of this review noted that their results are likely imprecise because only five studies (a total of 185 participants) were included in the analysis, and any conclusions made from the analysis should be considered preliminary.

Insomnia and Sleep Quality

Mindfulness meditation practices may help reduce insomnia and improve sleep quality.

• A 2019 analysis of 18 studies (1,654 total participants) found that mindfulness meditation practices improved sleep quality more than education-based treatments. However, the effects of mindfulness meditation approaches on sleep quality were no different than those of evidence-based treatments such as cognitive behavioral therapy and exercise.

Substance Use Disorder

Several clinical trials have investigated if mindfulness-based approaches such as mindfulness-based relapse prevention (MBRP) might help people recover from substance use disorders. These approaches have been used to help people increase their awareness of the thoughts and feelings that trigger cravings and learn ways to reduce their automatic reactions to those cravings.

• A 2018 review of 37 studies (3,531 total participants) evaluated the effectiveness of several mindfulness-based approaches to substance use disorder treatment and found that they significantly decreased participants’ craving levels. The mindfulness-based practices were slightly better than other therapies at promoting abstinence from substance use.
• A 2017 analysis specifically focused on MBRP examined 9 studies (901 total participants) of this approach. The analysis concluded that MBRP was not more effective at preventing substance use relapses than other treatments such as health education and cognitive behavioral therapy. However, MBRP did slightly reduce cravings and symptoms of withdrawal associated with alcohol use disorders.

Post-Traumatic Stress Disorder

Studies have suggested that meditation and mindfulness may help reduce symptoms of post-traumatic stress disorder (PTSD).

• A 2018 review supported by NCCIH examined the effects of meditation (in 2 studies, 179 total participants) and other mindfulness-based practices (in 6 studies, 332 total participants) on symptoms of PTSD. Study participants included veterans, nurses, and people who experienced interpersonal violence. Six of the eight studies reported that participants had a reduction of PTSD symptoms after receiving some form of mindfulness-based treatment.
• A 2018 clinical trial funded by the U.S. Department of Defense compared the effectiveness of meditation, health education, and prolonged exposure therapy, a widely accepted treatment for PTSD recommended by the American Psychological Association. Prolonged exposure therapy helps people reduce their PTSD symptoms by teaching them to gradually remember traumatic memories, feelings, and situations. The study included 203 veterans with PTSD as a result of their active military service. The results of the study showed that meditation was as effective as prolonged exposure therapy at reducing PTSD symptoms and depression, and it was more effective than PTSD health education. The veterans who used meditation also showed improvement in mood and overall quality of life.

Cancer

Mindfulness-based approaches may improve the mental health of people with cancer.

• A 2019 analysis of 29 studies (3,274 total participants) of mindfulness-based practices showed that use of mindfulness practices among people with cancer significantly reduced psychological distress, fatigue, sleep disturbance, pain, and symptoms of anxiety and depression. However, most of the participants were women with breast cancer, so the effects may not be similar for other populations or other types of cancer.

Weight Control and Eating Behavior

Studies have suggested possible benefits of meditation and mindfulness programs for losing weight and managing eating behaviors.

• A 2017 review of 15 studies (560 total participants) looked at the effects of mindfulness-based practices on the mental and physical health of adults with obesity or who were overweight. The review found that these practices were very effective methods for managing eating behaviors but less effective at helping people lose weight. Mindfulness-based approaches also helped participants manage symptoms of anxiety and depression.
• A 2018 analysis of 19 studies (1,160 total participants) found that mindfulness programs helped people lose weight and manage eating-related behaviors such as binge, emotional, and restrained eating. The results of the analysis showed that treatment programs, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, that combine formal meditation and mindfulness practices with informal mindfulness exercises were especially effective methods for losing weight and managing eating.

Attention-Deficit Hyperactivity Disorder

Several studies have been done on using meditation and mindfulness practices to improve symptoms of attention-deficit hyperactivity disorder (ADHD). However, the studies have not been of high quality and the results have been mixed, so evidence that meditation or mindfulness approaches will help people manage symptoms of ADHD is not conclusive.

How do meditation and mindfulness work?

Some research suggests that meditation and mindfulness practices may affect the functioning or structure of the brain. Studies have used various methods of measuring brain activity to look for measurable differences in the brains of people engaged in mindfulness-based practices. Other studies have theorized that training in meditation and mindfulness practices can change brain activity. However, the results of these studies are difficult to interpret, and the practical implications are not clear.

NCCIH-Funded Research

NCCIH supports a variety of meditation and mindfulness studies, including:

• An evaluation of how the brain responds to the use of mindfulness meditation as part of a combined treatment for migraine pain.
• A study of the effectiveness of mindfulness therapy and medication (buprenorphine) as a treatment for opioid use disorder.
• A study of a mindfulness training program designed to help law enforcement officers improve their mental health by managing stress and increasing resilience.

Tips To Consider

• Don’t use meditation or mindfulness to replace conventional care or as a reason to postpone seeing a health care provider about a medical problem.
• Ask about the training and experience of the instructor of the meditation or mindfulness practice you are considering.
• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions

For More Information

NCCIH Clearinghouse

The NCCIH Clearinghouse provides information on NCCIH and complementary and integrative health approaches, including publications and searches of Federal databases of scientific and medical literature. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners.

Toll-free in the U.S.: 1-888-644-6226

Telecommunications relay service (TRS): 7-1-1

Website: https://www.nccih.nih.gov

Email: info@nccih.nih.gov (link sends email)

NIH Clinical Research Trials and You

The National Institutes of Health (NIH) has created a website, NIH Clinical Research Trials and You, to help people learn about clinical trials, why they matter, and how to participate. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials.gov and other resources, and stories about the personal experiences of clinical trial participants. Clinical trials are necessary to find better ways to prevent, diagnose, and treat diseases.

Website: https://www.nih.gov/health-information/nih-clinical-research-trials-you

Key References

• Anheyer D, Leach MJ, Klose P, et al. Mindfulness-based stress reduction for treating chronic headache: a systematic review and meta-analysis. Cephalalgia. 2019;39(4):544-555.
• Black LI, Barnes PM, Clarke TC, Stussman BA, Nahin RL. Use of yoga, meditation, and chiropractors among U.S. children aged 4–17 years. NCHS Data Brief, no 324. Hyattsville, MD: National Center for Health Statistics. 2018.
• Breedvelt JJF, Amanvermez Y, Harrer M, et al. The effects of meditation, yoga, and mindfulness on depression, anxiety, and stress in tertiary education students: a meta-analysis. Frontiers in Psychiatry. 2019;10:193.
• Burke A, Lam CN, Stussman B, et al. Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States. BMC Complementary and Alternative Medicine. 2017;17(1):316.
• Carrière K, Khoury B, Günak MM, et al. Mindfulness‐based interventions for weight loss: a systematic review and meta‐analysis. Obesity Reviews. 2018;19(2):164-177.
• Cavicchioli M, Movalli M, Maffei C. The clinical efficacy of mindfulness-based treatments for alcohol and drugs use disorders: a meta-analytic review of randomized and nonrandomized controlled trials. European Addiction Research. 2018;24(3):137-162.
• Cillessen L, Johannsen M, Speckens AEM, et al. Mindfulness‐based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta‐analysis of randomized controlled trials. Psychooncology. 2019;28(12):2257-2269.
• Creswell JD. Mindfulness interventions. Annual Review of Psychology. 2017;68:491-516.
• Davidson RJ, Kaszniak AW. Conceptual and methodological issues in research on mindfulness and meditation. American Psychologist. 2015;70(7):581-592.
• Farias M, Maraldi E, Wallenkampf KC, et al. Adverse events in meditation practices and meditation-based therapies: a systematic review. Acta Psychiatrica Scandinavica. 2020;142(5):374-393.
• Garland EL, Brintz CE, Hanley AW, et al. Mind-body therapies for opioid-treated pain: a systematic review and meta-analysis. JAMA Internal Medicine. 2020;180(1):91-105.
• Goldberg SB, Tucker RP, Greene PA, et al. Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clinical Psychology Review. 2018;59:52-60.
• Grant S, Colaiaco B, Motala A, et al. Mindfulness-based relapse prevention for substance use disorders: a systematic review and meta-analysis. Journal of Addiction Medicine. 2017;11(5):386-396.
• Haller H, Breilmann P, Schröter M et al. A systematic review and meta‑analysis of acceptance and mindfulness‑based interventions for DSM‑5 anxiety disorders. Scientific Reports. 2021;11(1):20385.
• Hilton L, Hempel S, Ewing BA, et al. Mindfulness meditation for chronic pain: systematic review and meta-analysis. Annals of Behavioral Medicine. 2017;51(2):199-213.
• Hirshberg MJ, Goldberg SB, Rosenkranz M, et al. Prevalence of harm in mindfulness-based stress reduction. Psychological Medicine. August 18, 2020. [Epub ahead of print].
• Intarakamhang U, Macaskill A, Prasittichok P. Mindfulness interventions reduce blood pressure in patients with non-communicable diseases: a systematic review and meta-analysis. Heliyon. 2020;6(4):e03834.
• Khoo E-L, Small R, Cheng W, et al. Comparative evaluation of group-based mindfulness-based stress reduction and cognitive behavioural therapy for the treatment and management of chronic pain: a systematic review and network meta-analysis. Evidence-Based Mental Health. 2019;22(1):26-35.
• Levine GN, Lange RA, Bairey-Merz CN, et al. Meditation and cardiovascular risk reduction: a scientific statement from the American Heart Association. Journal of the American Heart Association. 2017;6(10):e002218.
• Nidich S, Mills PJ, Rainforth M, et al. Non-trauma-focused meditation versus exposure therapy in veterans with post-traumatic stress disorder: a randomised controlled trial. Lancet Psychiatry. 2018;5(12):975-986.
• Niles BL, Mori DL, Polizzi C, et al. A systematic review of randomized trials of mind-body interventions for PTSD. Journal of Clinical Psychology. 2018;74(9):1485-1508.
• Rogers JM, Ferrari M, Mosely K, et al. Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes. Obesity Reviews. 2017;18(1):51-67.
• Rosenkranz MA, Dunne JD, Davidson RJ. The next generation of mindfulness-based intervention research: what have we learned and where are we headed? Current Opinion in Psychology. 2019;28:179-183.
• Rusch HL, Rosario M, Levison LM, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Annals of the New York Academy of Sciences. 2019;1445(1):5-16.
• Schell LK, Monsef I, Wöckel A, et al. Mindfulness-based stress reduction for women diagnosed with breast cancer. Cochrane Database of Systematic Reviews. 2019;3(3):CD011518. Accessed at cochranelibrary.com on June 3, 2022.
• Semple RJ, Droutman V, Reid BA. Mindfulness goes to school: things learned (so far) from research and real-world experiences. Psychology in the Schools. 2017;54(1):29-52.
• Shires A, Sharpe L, Davies JN, et al. The efficacy of mindfulness-based interventions in acute pain: a systematic review and meta-analysis. Pain. 2020;161(8):1698-1707.
• Van Dam NT, van Vugt MK, Vago DR, et al. Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on Psychological Science. 2018;13(1):36-61.

Other References

• American Academy of Pediatrics Section on Integrative Medicine. Mind-body therapies in children and youth. Pediatrics. 2016;138(3):e20161896.
• Coronado-Montoya S, Levis AW, Kwakkenbos L, et al. Reporting of positive results in randomized controlled trials of mindfulness-based mental health interventions. PLoS One. 2016;11(4):e0153220.
• Dakwar E, Levin FR. The emerging role of meditation in addressing psychiatric illness, with a focus on substance use disorders. Harvard Review of Psychiatry. 2009;17(4):254-267.
• Goyal M, Singh S, Sibinga EMS, et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine. 2014;174(3):357-368.
• Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press; 2011.
• Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. American Journal of Psychiatry. 1992;149(7):936-943.
• Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008;300(11):1350-1352.
• McKeering P, Hwang Y-S. A systematic review of mindfulness-based school interventions with early adolescents. Mindfulness. 2019;10:593-610.
• Muratori P, Conversano C, Levantini V, et al. Exploring the efficacy of a mindfulness program for boys with attention-deficit hyperactivity disorder and oppositional defiant disorder. Journal of Attention Disorders. 2021;25(11):1544-1553.
• Nahin RL, Rhee A, Stussman B. Use of complementary health approaches overall and for pain management by US adults. JAMA. 2024;331(7):613-615.
• Poissant H, Mendrek A, Talbot N, et al. Behavioral and cognitive impacts of mindfulness-based interventions on adults with attention-deficit hyperactivity disorder: a systematic review. Behavioural Neurology. 2019;2019:5682050.
• Skelly AC, Chou R, Dettori JR, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review no. 227. Rockville, MD: Agency for Healthcare Research and Quality; 2020. AHRQ publication no. 20-EHC009.
• Stieger JR, Engel S, Jiang H, et al. Mindfulness improves brain–computer interface performance by increasing control over neural activity in the alpha band. Cerebral Cortex. 2021;31(1):426-438.
• Teasdale JD, Segal ZV, Williams JMG, et al. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology. 2000;68(4):615-623.
• Weng HY, Lewis-Peacock JA, Hecht FM, et al. Focus on the breath: brain decoding reveals internal states of attention during meditation.Frontiers in Human Neuroscience. 2020;14:336.
• Yoshida K, Takeda K, Kasai T, et al. Focused attention meditation training modifies neural activity and attention: longitudinal EEG data in non-meditators. Social Cognitive and Affective Neuroscience. 2020;15(2):215-223.
• Yuan JP, Connolly CG, Henje E, et al. Gray matter changes in adolescents participating in a meditation training. Frontiers in Human Neuroscience. 2020;14:319.
• Zhang J, Díaz-Román A, Cortese S. Meditation-based therapies for attention-deficit/hyperactivity disorder in children, adolescents and adults: a systematic review and meta-analysis. Evidence-Based Mental Health. 2018;21(3):87-94.

Acknowledgments

Thanks to Elizabeth Ginexi, Ph.D., Erin Burke Quinlan, Ph.D., and David Shurtleff, Ph.D., NCCIH, for their review of this 2022 publication.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

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