Meditation

Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance. ^[1] Two commonly studied styles are focused attention meditation, which entails voluntarily focusing attention on a chosen object, and open monitoring meditation, which involves nonreactive monitoring of the content of experience from moment to moment. ^[1] Mindfulness-based stress reduction is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. ^[2]

Meditation and mindfulness have been shown to induce neuroplasticity, increase cortical thickness, reduce amygdala reactivity, and improve brain connectivity, leading to improved emotional regulation, cognitive function, and stress resilience. ^[3] In a meta-analysis, all meditation subtypes reduced systolic blood pressure, and when all forms were analysed together meditation reduced cortisol, C-reactive protein, blood pressure, heart rate, triglycerides, and tumour necrosis factor-alpha. ^[4] Preliminary functional neuroimaging studies are consistent with mindfulness improving emotional regulation by enhancing cortical regulation of limbic circuits and attentional control. ^[5]

A systematic review and meta-analysis of 47 trials with 3515 participants found that mindfulness meditation programs had moderate evidence of improved anxiety, depression, and pain, and low evidence of improved stress and mental health-related quality of life. ^[6] In the same review, effect sizes for anxiety were 0.38 at 8 weeks and for depression 0.30 at 8 weeks, and there was no evidence that meditation programs were better than active treatments such as drugs, exercise, or other behavioral therapies. ^[6] A meta-analysis of mindfulness-based interventions across 142 samples and 12,005 participants found they were superior to no treatment with an effect size of 0.55 but did not differ from evidence-based treatments. ^[7] A meta-analysis of mindfulness-based stress reduction in healthy individuals across 29 studies found it moderately effective in reducing stress, depression, anxiety, and distress, with results maintained at an average of 19 weeks of follow-up. ^[8] There is moderate strength of evidence that mindfulness meditation significantly improves sleep quality compared with nonspecific active controls, but low strength of evidence that it has no effect compared with specific active controls such as evidence-based sleep treatments. ^[9]

Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress, and should be prepared to discuss the role a meditation program could have with their patients. ^[6] Mindfulness-based interventions are effective for improving many biopsychosocial conditions including depression, anxiety, stress, insomnia, addiction, pain, and hypertension, and are relatively safe. ^[10] A limitation of the field is that many mindfulness systematic reviews and meta-analyses indicate low quality of the included studies, so higher-quality studies with adequate sample sizes and longer follow-up are needed. ^[10]