Review articleThe efficacy of meditation-based mind-body interventions for mental disorders: A meta-review of 17 meta-analyses of randomized controlled trials
Introduction
In recent years there has been a renewed optimism towards recovery in people with mental disorders (Ozonoff, 2013; Vita and Barlati, 2018). However, the long-term treatment effects are being questioned (Cortese et al., 2018). For example, for many people with mental disorders, psychotropic medication does not result in clinically meaningful improvement in the long-term and the side-effects are considerable (De Hert et al., 2012; Vancampfort et al., 2015). These side-effects often result in medication discontinuation and distress and can negatively impact patients’ life (Ashoorian et al., 2015; Ostrow et al., 2017; Wykes et al., 2017). The renewed optimism therefore mainly comes from the increasing evidence for non-pharmacological interventions, and in particular from modifying the unhealthy lifestyles that may be common in people with a mental disorder (Ashdown-Franks et al., 2019; Gee et al., 2019; Teasdale et al., 2017; Vancampfort et al., 2019). Lifestyle interventions are therefore increasingly being considered as an important component of treatment. For example, physical activity (PA) is now acknowledged as an effective first-line or adjunctive treatment for improving mental and physical symptoms across a broad range of mental disorders (Ashdown-Franks et al., 2019; Firth et al., 2020).
Within lifestyle interventions for people with a mental disorder, there is growing interest in mind-body interventions as an adjunctive treatment for mental disorders. For instance, 26% of those with depression and 34% of those with anxiety spectrum disorders in the US reported using meditation-based mind-body interventions (MBIs) in the management of their condition (Wolsko et al., 2003). Mind-body complementary health approaches are a diverse group of health care practices focused on the relationships between the mind, body, brain, and behaviour that are not currently considered a part of conventional medicine (Gellis, 2017). While there are many mind-body therapy approaches (Gellis, 2017), in this meta-review we will focus on the MBIs mindfulness, qigong, tai chi, and yoga. These are characterized by incorporating exercises including controlled physical movements, full-body stretching, breathing techniques, and a meditation component. The meditation component mainly consists of basic training of internal concentration by focusing the body and/or breathing, and leads to an altered dynamic of consciousness. Meditation practice is essentially a practice of awareness and all the considered interventions share fundamental meditation exercises such as sited meditation or body-scans (Sabe et al., 2019). All these MBIs require active involvement from the participant, are popular in the general population, often integrated in multidisciplinary mental health programs, and have great potential for dissemination in low resource settings because they are typically delivered in group settings with minimal need for equipment.
Several professional organizations have recently published statements or practice guidelines regarding the use of MBIs, including the UK National Institute for Health and Care Excellence (2018) and the Canadian Network for Mood and Anxiety Treatments (CANMAT) (Ravindran et al., 2016). Although recommendations from these organizations support, for example, the use of mindfulness or yoga as add-on treatment for mild to moderate depression, recommendations for other MBIs are more equivocal, mainly because of a lack of a comprehensive, methodologically robust summary of the available evidence.
Despite the common use of MBIs in the treatment of mental disorders, there is no summary of the evidence, nor is there a direct quantitative comparison of the evidence between all individual and/or combined MBIs. Moreover, the quality of these meta-analyses and the included trials has not been comprehensively evaluated, which is an indispensable step before more rigorous recommendations regarding MBIs in mental health care programs can be made (Gureje et al., 2015). Clear recommendations are needed as meditation-based mind-body approaches are not only becoming more popular, but also only half of those who participate report this to their health practitioner (Cheung et al., 2007). Therefore, it is important for mental health professionals to be familiar with the benefits, but also risks of active MBIs in general and for specific approaches so that implementation of active MBIs can be discussed together with the patient.
In order to address the current gap within the literature, we set out to evaluate, compare and aggregate the existing evidence from the most recent/largest, published meta-analyses of randomized trials of different MBIs (i.e. mindfulness, qigong, tai chi, and yoga) in people with a mental disorder in order to determine the quality of evidence and magnitude of efficacy for MBIs targeting mental health outcomes. Moreover, we provide an overview of the reported adverse events and attrition rates.
Section snippets
Searches
Two independent authors (DV and TVD) searched MEDLINE/PubMed, PsycARTICLES and EMBASE from inception to 06/2020, for systematic reviews with meta-analyses of randomised controlled trials (RCTs) investigating MBIs as add-on or sole treatment across a range of mental disorders. Separate searches were undertaken for each mental disorder categorisation using the following standard terms: (mind-body, mindfulness, qigong, tai chi, yoga) and (systematic review or meta-analysis or meta* or metanalytic
Systematic search results
Of 4009 search engine hits, 17 meta-analyses were included (Chi et al., 2018; Chu et al., 2018; Cramer et al., 2013, 2018; Goldberg et al., 2018; Grant et al., 2017; Guo et al., 2019; Hartley et al., 2019; Hopwood and Schutte, 2017; Jansen et al., 2019; Kuyken et al., 2016; Miller et al., 2020; Sabe et al., 2019; Vollbehr et al., 2018; Xue et al., 2019; Zhang et al., 2018; Zheng et al., 2016) (see Fig. 1). There was one meta-analysis in mental disorders in general (Goldberg et al., 2018), one
Discussion
To our knowledge, this overview of 17 meta-analyses of RCTs is the first to systematically assess the effects of MBIs in people with a mental disorder. Our data sheds new light on the state of the current evidence base. The current overview may help guide clinical practice and set a precedent of where future research priorities should focus.
In summary, we found potential large effects (i.e. effect sizes of at least 0.8) (Higgins et al., 2003) in meta-analyses with good methodological quality
Declaration of competing interest
There are no conflicts of interest to report.
Acknowledgements
The authors would like to thank Melissa Eaton (Western Sydney University, Sydney, NSW, Australia) for her assistance in the data collection.
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