Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review

Modi Alsubaie; Rebecca Abbott; Barnaby Dunn; Chris Dickens; Tina Frieda Keil; William Henley; Willem Kuyken

doi:10.1016/j.cpr.2017.04.008

Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review

Clin Psychol Rev. 2017 Jul:55:74-91. doi: 10.1016/j.cpr.2017.04.008. Epub 2017 Apr 23.

Authors

Modi Alsubaie¹, Rebecca Abbott², Barnaby Dunn³, Chris Dickens⁴, Tina Frieda Keil⁵, William Henley², Willem Kuyken⁶

Affiliations

¹ Mood Disorders Centre, Exeter University, Exeter, UK. Electronic address: msfa202@exeter.ac.uk.
² Medical School, Exeter University, Exeter, UK.
³ Mood Disorders Centre, Exeter University, Exeter, UK.
⁴ Psychology, Medical School, Exeter University, Exeter, UK.
⁵ Psychology Department, Exeter University, Exeter, UK.
⁶ Psychiatry Department, Oxford University, Oxford, UK. Electronic address: willem.kuyken@psych.ox.ac.uk.

PMID: 28501707
DOI: 10.1016/j.cpr.2017.04.008

Abstract

Background: Recently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified.

Purpose: The aim of this paper is to review, systematically, the evidence to date on the mechanisms of action in mindfulness interventions in populations with physical and/or psychological conditions.

Method: Searches of seven databases (PsycINFO, Medline (Ovid), Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, AMED, ClinicalTrials.gov) were undertaken in June 2014 and July 2015. We evaluated to what extent the studies we identified met the criteria suggested by Kazdin for establishing mechanisms of action within a psychological treatment (2007, 2009).

Results: We identified four trials examining mechanisms of mindfulness interventions in those with comorbid psychological and physical health problems and 14 in those with psychological conditions. These studies examined a diverse range of potential mechanisms, including mindfulness and rumination. Of these candidate mechanisms, the most consistent finding was that greater self-reported change in mindfulness mediated superior clinical outcomes. However, very few studies fully met the Kazdin criteria for examining treatment mechanisms.

Conclusion: There was evidence that global changes in mindfulness are linked to better outcomes. This evidence pertained more to interventions targeting psychological rather than physical health conditions. While there is promising evidence that MBCT/MBSR intervention effects are mediated by hypothesised mechanisms, there is a lack of methodological rigour in the field of testing mechanisms of action for both MBCT and MBSR, which precludes definitive conclusions.

Keywords: MBCT; MBSR; Mechanisms; Physical conditions; Psychological conditions; Systematic review.

Publication types

Review
Systematic Review

MeSH terms

Anxiety Disorders / therapy*
Depressive Disorder / therapy*
Heart Diseases / psychology*
Humans
Mental Disorders / therapy*
Mindfulness / methods*
Neoplasms / psychology*
Outcome Assessment, Health Care*
Stress, Psychological / therapy*