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Undergraduate and graduate students show elevated levels of stress and could thus benefit from mindfulness interventions, but the best way to teach mindfulness has not been established. The present study compared a stress management program that used formal meditations and informal practice (Mindful Stress Management; MSM) to one that used brief mindfulness exercises and informal practice (Mindful Stress Management-Informal; MSM-I), and a wait-list control. MSM participants exhibited significant within-group changes on all measures, and when compared to the wait-list control, greater levels of mindfulness, decentering, and self-compassion, as well as lower stress. Students in MSM-I had significant within-group changes on a subset of measures, and greater mindfulness and self-compassion compared to the wait-list. MSM participants showed more improvement in self-compassion, psychological inflexibility, and stress than did those in MSM-I. Mediational analyses found increases in one facet of mindfulness and self-compassion, and decreases in worry mediated reductions in stress for MSM participants, while no mediator reached significance for MSM-I. Finally, no significant relation between amount of formal meditation and informal practice and reductions in psychological distress or increases in mindfulness was found. Results suggest that a program with formal meditations and informal practice may be a more promising intervention for university student stress than one with brief mindfulness exercises and informal practice.
IMPORTANCE:Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation. OBJECTIVE: To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations. EVIDENCE REVIEW: We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. FINDINGS: After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies). CONCLUSIONS AND RELEVANCE: Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.