Self-reported mindfulness accounts for the effects of mindfulness interventions and nonmindfulness controls on self-reported mental health: A preregistered systematic review and three-level meta-analysis of 146 randomized controlled trials.

Abstract

Meta-analyses suggest that mindfulness interventions have positive effects on mental health. Yet, how mindfulness interventions exert their effects is still largely unknown. Self-reported mindfulness may partially mediate the association between mindfulness interventions and change in self-reported mental health. We present the results of a novel application of three-level meta-analysis on the pre-post intervention data of 146 RCTs of mindfulness interventions (total N = 10,979), probing the efficacy of a broad range of mindfulness interventions and meditation training against active, treatment-as-usual (TAU), and wait-list control groups. We found that self-reported mindfulness not only increased in mindfulness interventions (d = 0.54, 95% CI [0.47, 0.61]), but also in active (nonmindfulness) controls (d = 0.27 [0.18, 0.36]) and wait-list controls (d = 0.10 [0.04, 0.17]; but not TAU controls: d = 0.04 [−0.03, 0.12]). In addition, change in mindfulness accounted for change in self-reported mental health (mindfulness interventions: d = 0.65 [0.57, 0.73]; active controls: d = 0.49 [0.36, 0.62]; TAU controls: d = 0.20 [0.12, 0.29]; wait-list controls: d = 0.22 [0.14, 0.30]) in all treatment and control groups alike. Thus, self-reported mindfulness apparently is no unique mediator of mindfulness interventions. It may either be more universal, merely a correlate of self-reported mental health, or both. Research should focus on the common denominator of mindfulness interventions and clinically relevant constructs with which self-reported mindfulness shares some of its characteristics. Limitations pertain to the indirect evidence of the three-level meta-analytic approach, the self-report nature of the data, and small-study effects, which suggest the presence of publication bias. The risk of bias may have led to the overestimation of effects and results could further be subjected to effects of shared method variance. Public Significance StatementThis meta-analysis suggests that increases in self-reported mindfulness may explain the treatment efficacy of various mindfulness-based interventions, but also of nonmindfulness-based controls. Selfreported mindfulness thus may be no unique mediator of the effects of mindfulness interventions. The current evidence leaves open whether self-reported mindfulness might be a universal mediator of treatment effects, merely reflects changes of self-reported mental health in general, or both.

Efficacy and feasibility of the minimal therapist-guided four-week online audio-based mindfulness program ‘Mindful Senses’ for burnout and stress reduction in medical personnel: A randomized controlled trial

“…We hypothesize that the PSA that Group B read might promote acceptance level to some degree, leading to non-different acceptance scores between groups. A 2022 meta-analysis [47] supports our hypothesis reporting that self-reported mindfulness is nonunique to mindfulness intervention, and can be increased by non-mindfulness interventions, even in a wait-list control group that received no intervention. Another considerable possible explanation of non-different acceptance level between groups is that acceptance attitude might appear more in those who practice mindfulness for prolonged periods of time.…”

Efficacy and Feasibility of the Minimal Therapist-Guided Four-Week Online Audio-Based Mindfulness Program ‘Mindful Senses’ for Burnout and Stress Reduction in Medical Personnel: A Randomized Controlled Trial

“…We hypothesize that the PSA that Group B read might promote acceptance level to some degree, leading to non-different acceptance scores between groups. A 2022 meta-analysis [ 47 ] supports our hypothesis reporting that self-reported mindfulness is non-unique to mindfulness intervention and can be increased by non-mindfulness interventions, even in a wait-list control group that received no intervention. Another considerable possible explanation of non-different acceptance level between groups is that an acceptance attitude might appear more in those who practice mindfulness for prolonged periods of time.…”

The Effects of Mindfulness-Based Interventions on Telomere Length and Telomerase Activity: A Systematic Review and Meta-Analysis

“…Yet, to the extent that MBIs do appear to increase TA, it could be used as an objective measure for the efficacy of mindfulness interventions. It could complement, or replace, more subjective self-ratings of psychometric mindfulness or mental health in this field of research (Goldberg et al, 2022;Tran et al, 2022). This needs to be addressed in future research, which also needs to investigate in more detail the exact conditions under which either high or low telomerase levels can be considered a marker for good or improved cellular health (Epel, 2012).…”

“…However, concerns regarding the risk of bias in primary studies and publication bias suggested that the current meta-analytic summary effects still may have been overestimated and the utilized search strategy may have been suboptimal in retrieving non-English studies as only the first 500 hits in Google Scholar were screened for eligibility in the second stage of the literature search. Study quality needs to be increased in this field of research (see also Goldberg et al, 2022;Tran et al, 2022) problems of available studies. Larger samples are needed to increase studies' analytic power.…”

“…This, in turn, may lead to a reduction of stress and better health. Other models of change highlight, for example, the four interrelated components of attention regulation, body awareness, emotion regulation, and change in the perspective on the self (Hölzel et al, 2011); self-awareness, self-regulation, selftranscendence, and six underlying neurocognitive networks (S-ART; Vago & Silbersweig, 2012); or attention monitoring and acceptance (MAT; Lindsay & Creswell, 2017) to explain the effects of MBIs on mental health (for an overview on these models, see also Tran et al, 2022).…”