A skeptical look at mindfulness-based training for physical health problems

Abstract

Background: Mindfulness-based training (MSBT) is widely recommended for improving both physical and functional outcomes in chronic health problems. This presentation evaluates the quality of evidence supporting such recommendations. Methods: A systematic narrative review identifies key meta-analyses and randomized trials evaluating MSBT for physical health problems. Key findings will be evaluated with respect to quality of conduct and reporting and the influence of conflicts of interest on results. . Findings: Strong findings are claimed in meta-analyses for MSBT across a full range of chronic physical and mental health problems. However, when these meta-analyses are evaluated in terms of standard measures of quality and conflict of interest, a clear pattern emerges. Positive findings are largely limited to poor quality meta-analyses from authors with conflicts of interest. High-quality comprehensive meta-analyses fail to identify many benefits of MSBT versus other active treatments. In terms of RCTs, positive findings are largely limited to subjective self-report in comparisons with no treatment and inadequate control conditions. Overall quality of RCTs is low. Claims about MSBT influencing immune and brain function in any unique or clinically significant fashion are as yet unwarranted. Whether patients assigned to mindfulness training actually practice is seldom assessed and results are mixed. Under conditions in which MSBT is typically evaluated, acupuncture would appear effective. Discussion: Clinicians and policymakers need to be alert to the overall poor quality of meta-analyses and randomized trials from promoters of MSBT. There is little need for further research comparing MSBT to no treatment or inadequate control conditions.