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When science meets mindfulness

Researchers study how it seems to change the brain in depressed patients

Alvin Powell

Harvard Staff Writer

First of two parts

In 2015, 16.1 million Americans reported experiencing major depression during the previous year, often struggling to function while grappling with crippling darkness and despair.

There’s an arsenal of treatments at hand, including talk therapy and antidepressant medications, but what’s depressing in itself is that they don’t work for every patient.

“Many people don’t respond to the frontline interventions,” said Benjamin Shapero, an instructor in psychiatry at Harvard Medical School (HMS) and a psychologist at Massachusetts General Hospital’s (MGH) Depression Clinical and Research Program . “Individual cognitive behavioral therapy is helpful for many people; antidepressant medications help many people. But it’s also the case that many people don’t benefit from them as well. There’s a great need for alternative approaches.”

Shapero is working with Gaëlle Desbordes , an instructor in radiology at HMS and a neuroscientist at MGH’s Martinos Center for Biomedical Imaging , to explore one alternative approach: mindfulness-based meditation.

In recent decades, public interest in mindfulness meditation has soared. Paralleling, and perhaps feeding, the growing popular acceptance has been rising scientific attention. The number of randomized controlled trials — the gold standard for clinical study — involving mindfulness has jumped from one in the period from 1995‒1997 to 11 from 2004‒2006, to a whopping 216 from 2013‒2015, according to a recent article summarizing scientific findings on the subject.

Studies have shown benefits against an array of conditions both physical and mental, including irritable bowel syndrome, fibromyalgia, psoriasis, anxiety, depression, and post-traumatic stress disorder. But some of those findings have been called into question because studies had small sample sizes or problematic experimental designs. Still, there are a handful of key areas — including depression, chronic pain, and anxiety — in which well-designed, well-run studies have shown benefits for patients engaging in a mindfulness meditation program, with effects similar to other existing treatments.

“There are a few applications where the evidence is believable. But the effects are by no means earth-shattering,” Desbordes said. “We’re talking about moderate effect size, on par with other treatments, not better. And then there’s a bunch of other things under study with preliminary evidence that is encouraging but by no means conclusive. I think that’s where it’s at. I’m not sure that is exactly how the public understands it at this point.”

Desbordes’ interest in the topic stems from personal experience. She began meditating as a graduate student in computational neuroscience at Boston University, seeking respite from the stress and frustration of academic life. Her experience convinced her that something real was happening to her and prompted her to study the subject more closely, in hopes of shedding enough light to underpin therapy that might help others.

“My own interest comes from having practiced those [meditation techniques] and found them beneficial, personally. Then, being a scientist, asking ‘How does this work? What is this doing to me?’ and wanting to understand the mechanisms to see if it can help others,” Desbordes said. “If we want that to become a therapy or something offered in the community, we need to demonstrate [its benefits] scientifically.”

Desbordes’ research uses functional magnetic resonance imaging (fMRI), which not only takes pictures of the brain, as a regular MRI does, but also records brain activity occurring during the scan. In 2012, she demonstrated that changes in brain activity in subjects who have learned to meditate hold steady even when they’re not meditating. Desbordes took before-and-after scans of subjects who learned to meditate over the course of two months. She scanned them not while they were meditating, but while they were performing everyday tasks. The scans still detected changes in the subjects’ brain activation patterns from the beginning to the end of the study, the first time such a change — in a part of the brain called the amygdala — had been detected.

Functional MRI (left) showing activation in the amygdala when participants were watching images with emotional content before learning meditation. After eight weeks of training in mindful attention meditation (right) note the amygdala is less activated after the meditation training.

Courtesy of Gaelle Desbordes

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In her current work, she is exploring meditation’s effects on the brains of clinically depressed patients, a group for whom studies have shown meditation to be effective. Working with patients selected and screened by Shapero, Desbordes is performing functional magnetic resonance imaging scans before and after an eight-week course in mindfulness-based cognitive therapy, or MBCT.

During the scans, participants complete two tests, one that encourages them to become more aware of their bodies by focusing on their heartbeats (an exercise related to mindfulness meditation), and the other asking them to reflect on phrases common in the self-chatter of depressed patients, such as “I am such a loser,” or “I can’t go on.” After a series of such comments, the participants are asked to stop ruminating on the phrases and the thoughts they trigger. Researchers will measure how quickly subjects can disengage from negative thoughts, typically a difficult task for the depressed.

The process will be repeated for a control group that undergoes muscle relaxation training and depression education instead of MBCT. While it’s possible that patients in the control part of the study also will have reduced depressive symptoms, Desbordes said it should occur via different mechanisms in the brain, a difference that may be revealed by the scans. The work, which received funding from the National Center for Complementary and Integrative Health , has been underway since 2014 and is expected to last into 2019.

Desbordes said she wants to test one prevalent hypothesis about how MBCT works in depressed patients: that the training boosts body awareness in the moment, called interoception, which, by focusing their attention on the here and now, arms participants to break the cycle of self-rumination.

“We know those brain systems involved with interoception, and we know those involved with rumination and depression. I want to test, after taking MBCT, whether we see changes in these networks, particularly in tasks specifically engaging them,” Desbordes said.

Desbordes is part of a community of researchers at Harvard and its affiliated institutions that in recent decades has been teasing out whether and how meditation works.

In the 1970s, when transcendental meditation surged in popularity, Herbert Benson, a professor at Harvard Medical School and what was then Beth Israel Hospital, explored what he called  “The Relaxation Response,” identifying it as the common, functional attribute of transcendental meditation, yoga, and other forms of meditation, including deep religious prayer. Benson described this response — which recent investigators say is not as common as he originally thought — as the opposite of the body’s adrenalin-charged “fight or flight” response, which was also identified at Harvard, by physiologist Walter Cannon Bradford in 1915.

Other MGH researchers also are studying the effects of meditation on the body, including Sara Lazar , who in 2012 used fMRI to show that the brains of subjects thickened after an eight-week meditation course. Work is ongoing at MGH’s Benson-Henry Institute ; at HMS and Brigham and Women’s Hospital’s Osher Center for Integrative Medicine ; at the Harvard-affiliated Cambridge Health Alliance, where Zev Schuman-Olivier directs the Center for Mindfulness and Compassion ; and among a group of nearly a dozen investigators at Harvard and other Northeastern institutions, including Desbordes and Lazar, who are collaborating through the Mindfulness Research Collaborative .

Among the challenges researchers face is defining mindfulness itself. The word has come to describe a meditation-based practice whose aim is to increase one’s sense of being in the present, but it has also been used to describe a nonmeditative state in which subjects set aside their mental distractions to pay greater attention to the here and now, as in the work of Harvard psychologist Ellen Langer .

Another challenge involves sorting through the many variations of meditative practice.

Recent scientific exploration has largely focused on the secular practice of mindful meditation, but meditation is also a component of several ancient religious traditions, with variations. Even within the community practicing secular mindful meditation, there are variations that may be scientifically meaningful, such as how often one meditates and how long the sessions are. Desbordes herself has an interest in a variation called compassion meditation, whose aim is to increase caring for those around us.

Amid this variation, an eight-week mindfulness-based stress reduction course developed in the 1970s by Jon Kabat-Zinn at the University of Massachusetts Medical Center has become something of a clinical and scientific standard. The course involves weekly two- or 2½-hour group training sessions, 45 minutes of daily work on one’s own, and a daylong retreat. The mindfulness-based cognitive therapy used in Desbordes’ current work is a variation on that program and incorporates elements of cognitive behavioral therapy, which involves talk therapy effective in treating depression.

Ultimately, Desbordes said she’s interested in teasing out just what in mindful meditation can work against depression. If researchers can identify what elements are effective, the therapy may be refined to be more successful. Shapero is also interested in using the study to refine treatment. Since some patients benefit from mindfulness meditation and some do not, he’d like to better understand how to differentiate between the two.

“Once we know which ingredients are successful, we can do more of that and less, maybe, of the parts that are less effective,” Desbordes said.

Research funding includes the National Center for Complementary and Integrative Health.

For more information about the Mindfulness & Meditation program at Harvard University, visit its website.

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Mindfulness meditation: A research-proven way to reduce stress

Mindfulness meditation can improve both mental and physical health.

• Mindfulness
• Mental Health

People have been meditating for thousands of years, often as part of a spiritual practice. But in more recent years, mindfulness has become a popular way to help people manage their stress and improve their overall well-being — and a wealth of research shows it’s effective. Psychologists have found that mindfulness meditation changes our brain and biology in positive ways, improving mental and physical health.

What is mindfulness meditation?

Meditation can be defined in many ways. But a simple way to think of it is training your attention  to achieve a mental state of calm concentration and positive emotions.

Mindfulness is one of the most popular meditation techniques. It has two main parts: attention and acceptance.

The attention piece is about tuning into your experiences to focus on what's happening in the present moment. It typically involves directing your awareness to your breath, your thoughts, the physical sensations in your body and the feelings you are experiencing. The acceptance piece involves observing those feelings and sensations without judgment. Instead of responding or reacting to those thoughts or feelings, you aim to note them and let them go.

Mindfulness classes and mindfulness-based therapies provide the tools to put those concepts into practice. Such programs might include breathing exercises, yoga and guided lessons to help you become aware of your body sensations, thoughts and feelings.

Much of the research on mindfulness has focused on two types of interventions:

• Mindfulness-based stress reduction (MBSR) is a therapeutic intervention that involves weekly group classes and daily mindfulness exercises to practice at home, over an 8-week period. MBSR teaches people how to increase mindfulness through yoga and meditation.
• Mindfulness-based cognitive therapy (MBCT) is a therapeutic intervention that combines elements of MBSR and cognitive behavioral therapy (CBT) to treat people with depression.

Researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for  reducing stress, anxiety and depression . Mindfulness can also help treat people with specific problems including depression, pain, smoking and addiction . Some of the most promising research has looked at people with depression. Several studies have found, for example, that MBCT can significantly reduce relapse in people who have had previous episodes of major depression . What's more, mindfulness-based interventions can  improve physical health , too. For example, mindfulness may  reduce pain, fatigue and stress in people with chronic pain . Other studies have found preliminary evidence that mindfulness might  boost the immune system and help people recover more quickly from cold or flu.

How mindfulness works

How could simply tuning into your thoughts and feelings lead to so many positive outcomes throughout the body? Researchers believe the benefits of mindfulness are related to its ability to dial down the body's response to stress.

Chronic stress can impair the body's immune system and make many other health problems worse. By lowering the stress response, mindfulness may have downstream effects throughout the body.

Psychological scientists have found that mindfulness influences  two different stress pathways in the brain , changing brain structures and activity in regions associated with  attention and emotion regulation . Scientists are also beginning to understand which elements of mindfulness are responsible for its beneficial effects. In a review of meditation studies, psychology researchers found strong evidence that people who received MBCT were less  likely to react with negative thoughts or unhelpful emotional reactions in times of stress . They also found moderate evidence that people who participated in MBCT or MBSR were better able to focus on the present and less likely to worry and to think about a negative thought or experience over and over.

[ Related:  6 mental health tips psychologists use]

How to get started

Ready to give it a try? Learning mindfulness is easier than ever. Mindfulness classes and interventions are widely available in settings including yoga centers, athletic clubs, hospitals and clinics, though the classes can vary in their approach. Find a therapist trained in MBSR or MBCT — interventions that have the most evidence of benefits.

A number of mindfulness-based interventions are now available online or through smartphone apps as well, although more long-term research is needed to explore how they affect the body and the brain. Still, early studies have found that  online mindfulness-based interventions can have a positive effect on mental health .

It can take a little while for mindfulness meditation to feel natural and to become a part of your regular routine. But with practice, you may discover a powerful tool for relieving stress and improving well-being.

Thanks to psychologists J. David Creswell, PhD, and Bassam Khoury, PhD, who assisted with this article.

The Meeting of Meditative Disciplines and Western Psychology: A Mutually Enriching Dialogue Walsh, et. al., American Psychologist 2006

Mindfulness-Based Therapy: A Comprehensive Meta-Analysis Khoury, B., et. al. Clinical Psychology Review, 2013

Mindfulness-Based Interventions for Psychiatric Disorders: A Systematic Review and Meta-Analysis Goldberg, S.B., et. al. Clinical Psychology Review, 2018

Mindfulness Interventions Creswell, J.D., Annual Review of Psychology, 2017

Mindfulness Training and Physical Health: Mechanisms and Outcomes Creswell, J.D., et. al.,  Psychosomatic Medicine, 2019

Mindfulness and Cognitive–Behavioral Interventions for Chronic Pain: Differential Effects on Daily Pain Reactivity and Stress Reactivity Davis, M.C., et. al., Journal of Consulting and Clinical Psychology, 2015

Mindfulness Meditation and The Immune System: A Systematic Review of Randomized Controlled Trials Black, D.S., et. al. Annals of the New York Academy of Sciences, 2016

Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial Barrett, B., et. al., Annals of Family Medicine, 2012

The Neuroscience of Mindfulness Meditation Tan, Y.-Y., et. al., Nature Reviews Neuroscience, 2015

How Do Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction Improve Mental Health and Wellbeing? A Systematic Review and Meta-Analysis of Mediation Studies Gu, J., et. al. Clinical Psychology Review, 2015

Effectiveness of Online Mindfulness-Based Interventions in Improving Mental Health: A Review and Meta-Analysis of Randomised Controlled Trials Spijkerman, M.P.J., et. al., Clinical Psychology Review, 2016

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• Research article
• Open access
• Published: 06 August 2021

Mindfulness-based positive psychology interventions: a systematic review

• Joshua George Allen   ORCID: orcid.org/0000-0001-9662-9863 1 ,
• John Romate   ORCID: orcid.org/0000-0003-0487-7849 1 &
• Eslavath Rajkumar   ORCID: orcid.org/0000-0002-3012-0391 1  

BMC Psychology volume  9 , Article number:  116 ( 2021 ) Cite this article

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There are hundreds of mindfulness-based interventions in the form of structured and unstructured therapies, trainings, and meditation programs, mostly utilized in a clinical rather than a well-being perspective. The number of empirical studies on positive potentials of mindfulness is comparatively less, and their known status in academia is ambiguous. Hence, the current paper aimed to review the studies where mindfulness-based interventions had integrated positive psychology variables, in order to produce positive functioning.

Data were obtained from the databases of PubMed, Scopus, and PsycNet and manual search in Google Scholar. From the 3831 articles, irrelevant or inaccessible studies were eliminated, reducing the number of final articles chosen for review to 21. Interventions that contribute to enhancement of eudaimonia, hedonia, and other positive variables are discussed.

Findings include the potential positive qualities of MBIs in producing specific positive outcomes within limited circumstances, and ascendancy of hedonia and other positive variables over eudaimonic enhancement.

In conclusion, exigency of modifications in the existing MBIs to bring about exclusively positive outcomes was identified, and observed the necessity of novel interventions for eudaimonic enhancement and elevation of hedonia in a comprehensive manner.

Peer Review reports

Background of the study

Mindfulness, a practice of conscious non-judgmental awareness to the present, emerged in the Indian subcontinent approximately 2500 years ago [ 1 ]. Around four decades back, with the pioneering works of Kabat Zinn who had incorporated mindfulness into psychotherapy, the scientific application of mindfulness for health and well-being for specific contextual needs had started [ 2 ]. Since then and particularly in the last decade, academic interest in the area of mindfulness has been increasing and the applicability of mindfulness in various facets of life is also getting attention [ 3 , 4 , 5 , 6 , 7 , 8 ]. Most of the accessible Mindfulness-Based Interventions (MBIs) are either standalone therapies or facilitating therapies for various clinical disorders and problems. Although mindfulness contributes immensely to clinical psychology, the concept of mindfulness has a broader and vaster meaning, beyond clinical symptom reduction and toward positive human functioning and flourishing. In recent years, Positive Psychology Interventions (PPIs) that integrate mindfulness elements have shown some promising outcomes [ 1 , 9 , 10 ]. Still, there is a significant lack of clarity in the implementation of Mindfulness-Based Positive Psychology Interventions (MPIs) and their impact on positive human functioning. Hence the current study aims to find and analyze the mindfulness-based interventions from the existing literature which have also shown potentials to be a positive psychology intervention.

Beginning from Mindfulness-Based Stress Reduction (MBSR) proposed by Kabat Zinn in the 1970s, MBIs are mostly used in the clinical settings for managing disorders and supporting prognosis of disorders and diseases. As an attempt to balance this reductionist deficit-model of health, the well-being outcomes of MBIs are also studied, especially in recent years. A positive psychology intervention is defined as “an intervention, therapy, or activity, primarily aimed at increasing positive feelings, positive behaviors, or positive cognitions, as opposed to ameliorating pathology or fixing negative thoughts or maladaptive behavior patterns” [ 12 ]. In this context, an MPI is “a mindfulness-based intervention with the primary aim to enhance positive human functioning”. PPIs not only exert impact on positive variables, but also are effective among clinical populations—as standalone therapies or facilitating interventions—such as the individuals suffering from depression [ 11 , 12 ], affective disorders [ 13 ], generalized anxiety disorder [ 14 ], and eating disorders [ 15 ]. Apart from that, regardless of the nature of population, PPIs have the potential to enhance positive cognition, positive affect, positive behavior, and overall positive functioning and experiences. Integrating positive psychology with mindfulness, or accommodating mindfulness elements in psychotherapy, a number of MBIs are developed, however, the existing literature is insufficient to articulate the quality and quantity of the researches on MPIs. In order to fill this gap, research on the current status of MPIs is warranted.

Furthermore, well-being mainly consists of hedonia and eudaimonia, two highly correlated but distinct forms of well-being, with different characteristics [ 16 , 17 ]. Though they are not mutually exclusive or antagonistic to each other, their nature, intensity, and patterns of expression are singular. This paper attempts to consolidate major mindfulness-based interventions devised for the enhancement of positive functioning beyond clinical symptom reduction, with a given priority to determine the status of MPIs for eudaimonic enhancement. Secondary importance is given to MPIs or MBIs for hedonic well-being and other positive psychology variables such as hope, happiness, resilience, gratitude, flow, compassion, and improved psychological performance. Studies, where a positive psychology variable was just one among three or more dependent variables, were excluded due to their orientation toward the deficit model rather than to positive psychology.

The positive potentials of mindfulness

Eudaimonic enhancement.

Eudaimonia is originally a Greek term that can be translated from a subjective perspective as “happiness”, and from an objective point of view, as “flourishing” [ 18 ]. Broadly, eudaimonia is “the pursuit, manifestation, and/or experience of virtue, personal growth, self-actualization, flourishing, excellence, and meaning” [ 19 ]. The “mindfulness-to-meaning theory” proposed by Garland et al. [ 20 ], advocates that mindfulness broadens the awareness spectrum resulting in cognitive-reappraisal of events to include the positive possibilities of specific instances, that enable the individual to perceive the meaning and purpose of life experiences. The cumulative effects of meaningful positive experiences bring about eudaimonic well-being. And unlike hedonia, eudaimonia will gradually expand on its own without the support of any external agencies, and its possibilities are literally infinite. This nature of eudaimonia is elucidated by the concepts of “eudaimonic staircase” [ 21 ] and the “upside spiral of positive emotions” described in the broaden-and-build theory [ 22 ]. Thus, this review is expected to be a beneficial contribution to the existing scientific knowledge on the role of MBIs in utilizing the eudaimonic-enhancement capability of mindfulness. In addition, recognition of the current utility spectrum of MBIs would support better usage of those MBIs as eudaimonic enhancement tools, or signify the need of further explorations on MBIs for eudaimonic enhancement.

Hedonic enhancement

Hedonia or hedonic well-being shall be defined as “the pursuit and/or experience of pleasure, enjoyment, comfort, and reduced pain” [ 19 ]. Since pain reduction is an element of hedonia, all kinds of psychotherapies are, in a sense, involved in the augmentation of hedonic well-being. Along with eudaimonia, hedonia contributes to subjective well-being [ 18 ]. The efficacy of MBIs is associated with fulfillment of hedonic needs. Some studies have explored the relationship between mindfulness and hedonic well-being and confirmed the assumption that mindfulness functions in direct and indirect ways to induce pleasure and reduce pain [ 23 , 24 ]. Other than clinical symptom management, hedonia and its components can be induced by MBIs, independently as well as in combination with other positive variables. Enhancement of enjoyment [ 25 ], happiness [ 26 ], and positive affect [ 27 , 28 ] are a few examples. Although not always directly stated, improved hedonia—reduced pain and discomfort or improved pleasure and comfort—had been described in clinical literature where MBIs are utilized for therapeutic purpose. The existing literature recognizes the hedonic enhancement quality of mindfulness, but they are not being studied comprehensively. Hence, this review gives auxiliary importance to narrate the MBIs that produced hedonic well-being.

Increasing other positive outcomes

Theoretically and empirically, mindfulness is found to be connected with a number of positive psychology variables. Different MBIs often focus on a specific aspect such as compassion, relaxation, and cognitive skills. Literature suggests that MBIs are effectual in generating a number of positive outcomes such as hope [ 29 ], optimism [ 30 , 31 ], prosocial behavior [ 32 ], flow [ 33 ] working memory [ 34 ], and academic performance [ 35 ]. This paper also reviews MBIs that had produced positive outcomes in addition to eudaimonic and hedonic well-being, in expectation of identifying the extent of impact conceivable for an MPI.

Purpose of the study

This paper attempts to present a narrative/descriptive synthesis of the major MBIs with positive potentials. Firstly, it intends to identify standardized or empirically validated MPIs. Secondly, MBIs that produce positive functioning shall be recognized and their efficacy as an MPI will be verified. Further, the MBIs that improve hedonic well-being and/or other positive variables will also be reported. Finally, the study stands to recount the intention of MBIs in eudaimonic enhancement.

Data were drawn from three electronic databases—PubMed, Scopus, and PsycNet—and a manual search in Google Scholar, from the inception to 29 May 2020. Keyword string used for database search was “mindfulness intervention” and filters were “controlled clinical trials” and “randomized controlled trial” in PubMed; “articles” and “psychology” in Scopus; and “articles” in PsycNet.

Eligibility criteria

The inclusion criteria were: (i) studies with the application of mindfulness-based intervention regardless of the population characteristics such as age, gender, and ethnicity; (ii) experimental and quasi-experimental studies that compared the outcomes between individuals administered with and without an MBI; and (iii) studies with positive psychology variables as dependent variables. The exclusion criteria followed to eliminate the articles were: (i) review papers, (ii) medical/ neuropsychological researches, and (iii) studies with positive psychology variables as just one among three or more dependent variables.

Positive psychology outcomes considered included but not limited to general well-being, eudaimonic well-being, hedonic well-being, happiness, hope, grit, loving kindness, gratitude, empathy, and flourishing. Studies where positive psychology variable was just one among the three or more dependent variables were excluded. It was because the focus of the current research was to find the MBIs that produced positive psychology variables as outcomes (or positive outcomes); and due to the dichotomous nature of many psychological variables, they have a positive and negative continuum which can be reported as the presence or absence of either positive or negative end. If three or more dependent variables are assessing clinical or non-positive conditions, it is highly likely that the one positive variable among these is the absence of a clinical condition rather than a positive psychology outcome. For instance, well-being is often reported as the absence of a clinical condition such as anxiety or depression. Also, when majority of the outcome measures are related to non-positive variables, the intervention is less likely to be developed for positive impacts. Including such studies would redirect the focus of the study and unnecessarily increase the time, energy, and resources for conducting the research.

Review papers were excluded because the study focused on original researches that reported outcomes of an MBI. Papers on medical/ neuropsychological researches were also excluded because their focus was not identification of positive psychology variables as the outcome measures of MBIs. Rather than the physiological mechanisms behind exposure to an MBI, the current study focused on perceived enhancement of positive psychology variables.

Data collection

A complete database search on PubMed, Scopus, and PsycNet was carried out along with a manual search in Google Scholar (see Fig.  1 ). From the four electronic databases, 5045 articles were found, whose titles and abstracts were transferred to the reference management software Zotero on 29 May 2020. After elimination of duplicates, 3377 articles remained. The first author had screened the articles and removed 3234 articles that did not meet the inclusion criteria, leaving 143 articles for full-text review. In the list of 143 articles two articles were rejected due to unavailability of full-text. Rest of the 141 articles were scrutinized and 120 articles were removed that met the exclusion criteria—being review/meta-analytic papers, medical/ neuropsychological researches, or studies where positive psychology variables were just one among three or more dependent variables. At the first stage of elimination, the third author had verified 30% of the randomly chosen articles, and at the second stage of elimination the second and third authors had randomly chosen 30% of the full-text articles and cross-verified, after which 100% of consensus was confirmed regarding the exclusion and inclusion of the articles. Finally, 21 articles that reported an MBI with an anticipated impact on positive variables were chosen for the review. Risk of bias tool of Cochrane (2019 version) [ 36 ] was used to identify risk of bias of the finally chosen articles. In order to reduce any bias during the process of quality assurance, all of the authors had independently applied the tool among all the chosen studies. Except minor differences of opinion, which were resolved through references to literature and open discussions, no major conflicts had occurred. Studies were found to have low risk or some concerns, and none of the chosen studies had shown high risk.

PRISMA flow diagram [ 65 ]

Among the 21 articles analyzed, 22 studies were identified, out of which two studies consisted of clinical populations and 20 different normal populations. Collectively, these 22 studies had assessed the impact of the intervention on 134 dependent variables, and 105 of these were positive aspects (eudaimonia and related aspects = 65, hedonia and related variables = 8, general well-being = 7, other positive psychology variables = 25). The finally chosen studies showed a high heterogeneity in terms of research designs, types of intervention, and outcome measures, due to which a narrative/ descriptive synthesis of the data was employed. Table 1 shows the list of studies as indicated by the author name(s) and year of publication, subsequent research designs, sample size, intervention, dependent variables, duration of the intervention, the population to whom the intervention was administered, and the major findings related to the intervention. As per the aim of this review, scope of data analysis is limited to identification of interventions as MPIs or MBIs with expected impact on positive variables. The paper describes the results of the studies as it is reported by the authors. There is scope for further studies to verify the efficacy of the interventions and whether they would produce the positive outcomes they intended to generate or capable of generating.

Interventions and procedures

A brief account of the interventions, research design, and procedures are described in this section. Studies are categorized based on the nature of the interventions, aiming to convey better meaning of the elaborate narration. This section aims to identify the MBIs that have the potential to be an MPI. And the next section, ‘Outcomes of MBIs’, deals with categorizing studies based on the intention of the intervention to enhance eudaimonia or hedonia and other positive variables. Here, depending on the nature of the intervention, they are categorized into eight: (1) Psychotherapies, (2) MBIs for children, (3) Mindfulness apps (4) Positive Relationships, (5) Mindful Self Compassion, (6) Loving Kindness Meditation, (7) MBIs that may act as MPIs and (8) MPIs.

Psychotherapies

MBIs are commonly used as therapeutic strategies, even when the positive outcomes are being explored. In such a study, Nyklícek & Kuijpers [ 28 ] had applied the MBSR intervention among distressed adults using a randomized waitlist controlled trial. The study intended to find out if the effect of MBSR on stress, vital exhaustion, positive affect, negative affect, quality of life, mindfulness, and daily mindfulness were mediated by mindfulness. Another research carried out by Amutio et al. [ 37 ] attempted to estimate the effect of MBSR on mindfulness and relaxation states of 42 physicians. The primary aim of the study was to test the efficacy of MBSR in inducing relaxation among professionals from a highly distressing career background. Also, heart rate was included as a dependent variable in order to confirm that MBSR could act as a relaxation method at a physical level as well. Although relaxation is a byproduct of mindfulness, other possible positive outcomes that could have opened ways to enhance human well-being and flourishing, were not the object of focus in this study. In another study, de Vibe et al. [ 38 ] had reported a six-year-long longitudinal study, where the impact of a seven-week abridged MBSR is described. The study illustrates the well-being, coping, and mindfulness of 288 participants. Another popular psychotherapy that makes use of mindfulness is Acceptance and Commitment Therapy (ACT). A guided seven-week internet-delivered Acceptance and Commitment Therapy (iACT) was administered among 68 university students with high distress. The participants’ well-being (psychological, emotional, and social domains), life satisfaction, self-esteem, mindfulness, stress, anxiety, depression, psychological flexibility, and sense of coherence were assessed by eight psychological assessment tools [ 39 ]. Since the study had combined clinical and positive outcome measures and because the interaction among these variables was uncertain, it is safe to refrain from concluding that iACT would be useful as a positive psychology intervention. Mostly, the MBIs with psychotherapeutic properties are predominantly governed by deficit-reduction qualities and the positive outcomes are only consequential.

MBIs for children

Three of the reviewed studies had been conducted among children [ 32 , 40 , 41 ]. Eudaimonic well-being among children is an area in the scientific literature with extremely less empirical information [ 42 ]. And the operational definitions of eudaimonia assessed among children are found to be limited in scope. In a study that attempted to see the impact of an MBI among child population, Huppert & Johnson [ 41 ] had administered four 40 minutes of mindfulness classes, one session per week, to 155 boys belonging to the age group of fourteen and fifteen years. Pre and post-assessments were conducted on their mindfulness, resilience, well-being, and big-five personality variables. In another research, Flook et al. [ 32 ] had observed 68 preschool children who were administered with a 12-week Mindfulness-Based Kindness Curriculum. A randomized waitlist controlled design was employed to obtain the amount of their social competence (a combination of pro-social behavior and emotion regulation), sharing, delay of gratification, cognitive flexibility, inhibitory control, and academic performance. Devcich et al. [ 40 ] had carried out another study where a novel intervention namely “Pause, Breathe, Smile” was tested for its efficacy with an active-controlled pilot design, against an emotional literacy program. Duration for both of the programs was one-hour weekly sessions for eight weeks. The study assessed pre and post scores of 91 school children, on well-being—including hedonia and eudaimonia—and mindfulness. Considering that the target population is children, it is not to be expected to find a concept as complex as eudaimonia to be manipulated or measured effectively, particularly when the interventions do not follow a standardized procedure. Although mindfulness was taught, the studies did not primarily focus on the well-being or other positive functioning of the participants, possibly because of the difficulty in gathering information on positive experiences from children. Hence, the three different interventions adopted here cannot be considered as effective tools for enhancing well-being and flourishing, but they shall be useful tools for specific targeted behavioral modifications and academic performance.

Mindfulness apps

The use of online platforms for counselling and psychotherapy is becoming popular nowadays, especially since the outbreak of covid 19 pandemic in 2020 [ 43 , 44 ]. Not just the reduction of undesirable states of mind, but the enhancement of positive functioning is also getting wide acceptance at a global level [ 45 ]. There are a few commercial mindfulness-based applications accessible though smart phones that were also empirically validated through scientific researches. In this review of MBIs, two of the studies chosen had implemented two apps—“Calm” and “Headspace” to explore its impact on health and well-being. Bhayee et al. [ 46 ] had tested the therapeutic efficacy of a commercial neurofeedback assisted, technology-supported mindfulness training (NtsMT). The experimental group was exposed to the “Calm” app in a pre-planned manner with recorded instructions. They have used a randomized active-control trial among 26 participants. Electroencephalogram (EEG) was used as the neurofeedback mechanism, and the psychological variables assessed were attention and well-being. Champion et al. [ 47 ] had conducted another research using a self-guided mindfulness meditation app, “Headspace”. The introductory program of the Headspace, “Foundation 1 to 3” with 30 sessions (10 at each level), was administered to the participants. The minimum duration of a session was 10 min, and there was an option to increase the duration up to 15 and 20 min for second and third levels respectively. They have assessed the life satisfaction, stress, resilience, social impairment, depression, anxiety, hypochondriasis, and enjoyment and experience of 62 participants. Both of these studies had apparently anticipated reduced clinical symptoms from the interventions, and the range of positive outcomes assessed were too narrow, suggesting that the intended use of these apps, in the concerned studies, was not primarily positive functioning.

Positive relationships

Positive relationships is a component of eudaimonic well-being. Three studies selected for the review had utilized three different interventions with the principal aim of improving relationships. Carson et al. [ 48 ] had tested the effect of a novel intervention, Mindfulness-Based Relationship Enhancement (MBRE), on relationship satisfaction, relatedness, autonomy, interpersonal closeness, partner acceptance, relationship distress, spirituality, individual relaxation, and psychological distress. They had adopted a randomized waitlist controlled design and the participants were 44 relatively happy and non-distressed couples. Another MBI that aimed at improving ‘positive relationship’ was applied in a study by Coatsworth et al. [ 49 ]. They had tested the efficacy of the Mindfulness-Enhanced Strengthening Families Program (MSFP) against a standard of care condition and control groups. They have adopted a randomized controlled comparative effectiveness study design with 432 families. The intervention intended to impact interpersonal mindfulness in parenting, parent-youth relationship, youth behavior management, and parent well-being. MSFP was an adapted intervention meant to be a preventive measure to protect adolescents from substance use and behavior problems. With the added element of mindfulness in the adapted version of the intervention, some positive outcomes were also anticipated which were included as dependent variables. Kappen et al. [ 50 ] had conducted another study on positive relationship , using a brief 12-day online mindfulness program. Intended outcomes of this intervention were elevated relationship satisfaction, partner acceptance, and trait mindfulness. Adults who had been in a romantic relationship for at least one year were recruited through social networking sites. Despite being context-specific and not focusing on relationship enhancement in an exhaustive way, these interventions definitely throw some light on the status of MBIs that are considered to be relationship enhancers. Specifically, MBRE, MSFP, and the 12-day online mindfulness program are apparently effective to improve quality of relationships at specific contexts. Since these interventions are designed for healthier relationship between specific target populations, such as couples, the same interventions will not be sufficient to improve relationship quality in another situation.

Mindful self compassion (MSC)

MSC, an intervention developed by Neff and Germer [ 51 ], intends to build self compassion in both normal and clinical populations. It is fundamentally a mindfulness-based positive psychology intervention, which gives priority to self-compassion and secondary importance to mindfulness. Other outcomes resultant from compassion and mindfulness shall also be expected from MSC, but its focus is not shared with any further components of well-being or other positive psychology variables. The current review found two papers where three studies that employed MSC were reported. Neff & Germer [ 51 ] had performed a pilot study and another randomized waitlist controlled trial to examine the effect of the Mindful Self Compassion (MSC) program. The intervention was for eight weeks, one two-hour session per week. They have studied the impact of the intervention on self-compassion, mindfulness, connectedness, happiness, life satisfaction, depression, anxiety, and stress in the first study and have added two more dependent variables in the second study, which are avoidance, and compassion for others. In another study, Yela et al. [ 52 ] had explored the impact of a Mindful Self-Compassion (MSC) program on self-compassion, mindfulness, psychological well-being, anxiety, and depression among 61 psychology trainees. The intervention lasted for eight weeks, with a 2.5-hour session weekly. The MSC interventions applied in these three studies have acted as psychological tools to improve specific elements of eudaimonic and hedonic well-being, along with other factors. The positive impacts of the interventions were looked upon from the point of view of ‘improved well-being through improved mental health’ rather than enhancement of well-being, happiness, flourishing, or meaning in life. It is difficult to conclude whether MSC was effectively established as an MPI through the aforementioned studies, considering the nature of MPI as an intervention with primary focus on positive outcomes. Nevertheless, the study results indeed emphasize the positive potentials of MSC.

Loving kindness meditation (LKM)

LKM is a kind of Buddhist meditation that intends to induce “a feeling of warmth and caring for self and others” [ 53 ]. Among the 22 studies reviewed, two studies had incorporated interventions that utilized LKM. Fredrickson et al. [ 53 ], in their study, recruited 139 working adults into experimental and waitlist control groups and the former was administered with 13 measures that assessed 15 variables—mindfulness, agency thinking, pathway thinking, savoring beliefs, optimism, ego resilience, psychological well-being, dyadic adjustment, positive relations, illness symptoms, sleep quality, satisfaction with life, depression, differential emotions, and emotion experiences. LKM was provided to the former group that extended for seven weeks with one hour weekly sessions. In a different study, Sorensen et al. [ 54 ] had investigated the effects of a novel intervention called ‘Convergence’ that combined LKM and classic guitar music. The two active-controlled conditions were given either music alone or meditation alone. All three conditions were prolonged for three weeks, providing one session per week, and the participants were assessed for mindfulness, self-compassion, fears of compassion, stress and anxiety, and mental well-being. Both of these researches focused less on the positive qualities of the intervention. LKM is a meditation practice that involves mindfulness elements but with an additional intentional focus on warm and tender feelings toward oneself and the others. LKM strives to instill an attitude of loving-kindness and do not attempts to enhance any other psychological properties directly. But the study results indicate that it is sufficient to improve specific aspects of hedonic and eudaimonic well-being.

MBIs that may act as MPIs

Positive psychology is relatively young and the number of studies is not yet comparable with that of clinical psychology and other deficit-focused fields of psychology. But it is a rapidly developing area that overlaps with the studies on mindfulness. There were three researches in this review where the positive psychological variables were looked into more vigorously. One of these was reported by Rodríguez-Carvajal et al. [ 55 ] where a non-randomized controlled study was used among 73 participants to substantiate the effect of a three-week Mindfulness Integrative Model (MIM) on mindfulness, self-compassion, and positive states of mind. In another instance, Pogrebtsova et al. [ 56 ] had studied the impact of a five-day combined mindful-reappraisal intervention on students’ positive and negative experiences, positive re-appraisal, decentering, curiosity, and optimism. The sample consisted of 106 participants where 36 were in the experimental group, which was compared against a ‘standard of care’ condition and active control group. The third study was carried out by Vich et al. [ 57 ] where a modified intervention, ‘Relational Mindfulness Training’ (RMT) was administered to 75 management students, and their self-compassion, compassion, stress, mindfulness, and happiness were measured. Despite a larger part of well-being aspects being still unexplored, the positive potentials of MBIs are well-documented in these researches. Further studies shall unravel the actual positive qualities of these interventions.

Mindfulness-based positive psychology interventions (MPIs)

It sounds as if two studies had explored the exponential positive power of MBIs. Ivtzan et al. [ 58 ] had studied the impact of a novel MPI, eight-week online ‘Positive Mindfulness Program’ (PMP) on eudaimonic and hedonic well-being, stress, depression, mindfulness, gratitude, self-compassion, autonomy component of psychological well-being scale, self-efficacy, meaning in life, compassion for others, and appreciation for the present moment, among 168 adults from 20 different countries. They have used a randomized waitlist controlled trial with pre, post, and one-month follow up data. Here, PMP had tested both clinical and positive outcomes, but basically it is an intervention developed to improve well-being through nine specific components –(i) positive emotions, (ii) self-compassion, (iii) well-being (happiness), (iv) autonomy, (v) mindfulness, (vi) self-efficacy (strengths), (vii) meaning, (viii) compassion, and (ix) engagement (savoring)’ [ 1 ]. In a different study by Smith et al. [ 59 ], 31 meditating adults were assessed for quality of life, subjective well-being, well-being, valuing, psychological flexibility, mindfulness, and cognitive fusion. The experimental group consisted of 17 individuals who had practiced Dharma in Daily Life (DIDL) for 30 minutes per day, extending six days a week, for two years course period and six months follow-up period, and possibly beyond. DIDL indeed had undeniable positive impact, but the intensity and duration raises questions about its feasibility as a common MPI. Nevertheless, both PMP and DIDL show promising utility of MPIs for enhancement of eudaimonia, hedonia, and other specific positive variables.

Outcomes of MBIs

The reviewed studies vary greatly based on research designs, outcome measures, intensity and structure of interventions, and analytical methods adopted. Hence, due to this high heterogeneity, it was only possible to narrate a peripheral report of outcomes. Depending on the effect sizes of outcome measures, there is an extended scope for further studies which surpass the objectives of the current review. Here, based on the intended positive outcomes of the interventions, studies are categorized into: (1) Enhancement of eudaimonia, (2) Enhancement of hedonia, and (3) Enhancement of other positive variables.

Enhancement of eudaimonia

In a randomized controlled efficacy trial, Rasanen et al. [ 39 ] found that there is a significant increase in well-being, life satisfaction, and mindfulness among the participants who had exposed to the iACT. They had also reported less stress and depression. These effects were intact in a 12-month follow-up as well. The study results show the plausible impact of an MBI on well-being, life satisfaction, and mindfulness, that shall contribute to a sense of purposeful living, one of the different components of eudaimonia.

Devcich et al. [ 40 ] had administered a mindfulness-based intervention, ‘Pause, Breathe, Smile’, to 45 school children as part of a research. Compared to an active control group, the former children had shown higher mindfulness and well-being (hedonia, eudaimonia, and socially desirable responsibility). The MBI ‘Pause, Breathe, Smile’ is likely to contribute to the eudaimonic well-being of children, not in a comprehensive way but to a limited extent.

Carson et al. [ 48 ] had observed the significant positive impact of Mindfulness-Based Relationship Enhancement on relationship functioning and well-being of couples, even when the couples were relatively happy and non-distressed at the baseline level. They had received results that supported the beneficial effect of the MBI on all dependent variables that was maintained at a three-month follow-up. In their study, Coatsworth et al. [ 49 ] had applied MSFP for strengthening four conditions related to family functioning. They have concluded that MSFP improved interpersonal mindfulness in parenting, parent-youth relationships, youth behavior management, and parent well-being. Kappen et al. [ 50 ] reported that, after a 12-day online mindfulness practice, 56 participants with lower baseline mindfulness reported higher relationship satisfaction and partner acceptance compared to the control group. Otherwise, both the groups, regardless of the administration of mindfulness practice or psycho-education, showed no significant difference in the aforementioned variables. In these studies, three different interventions indicate the possible usage of MBIs for ‘positive relationships’, a component of eudaimonic well-being.

Yela et al. [ 52 ] had studied the effects of MSC program and found that it has a significant impact on self-compassion, mindfulness, and psychological well-being (PWB) or eudaimonia. Despite focusing on the enhancement of compassion alone, the intervention proved to be a potential MPI for eudaimonic enhancement.

Ivtzan et al. [ 58 ] had tested the impact of PMP, on 11 psychological variables. The result indicated that there was a significant difference between the experimental and control groups on the basis of their scores of all the 11 dependent variables, including eudaimonic and hedonic well-being, mindfulness, meaning in life, compassion, and gratitude. PMP focuses on enhancement of both hedonic and eudaimonic well-being and accounts promising outcomes as an MPI for eudaimonic enhancement.

Enhancement of hedonia

In a field experimental study, Fredrickson et al. [ 53 ] found that the practice of LKM improved participants’ positive emotions (amusement, awe, contentment, joy, gratitude, hope, interest, love, and pride, collectively), and its effect expanded beyond the duration of meditation and cumulated overtime. Pogrebtsova et al. [ 56 ] had administered a five-day mindful reappraisal intervention to 36 participants and acquired results that suggest a decrease in negative affect and increase in positive affect toward the end of the intervention, compared to the scores of an active control and a standard of care conditions. Smith et al. [ 59 ] elucidated an instance when 17 participants were studied against a control group of 14 after getting exposed to DIDL intervention. It was stated that the experimental group, post-intervention, reported higher subjective well-being, well-being, mindfulness, psychological flexibility, and valuing. Nyklicek & Kuijpers [ 28 ] had narrated the impact of MBSR on stress, vital exhaustion, positive affect, quality of life, and mindfulness, in a randomized controlled trial. Compared to the control group, individuals exposed to the MBSR reported decreased stress and vital exhaustion, and increased positive affect, quality of life, and mindfulness. In a study using MIM, Rodriguez-Carvajal et al. [ 55 ] had found that the intervention enhanced mindfulness, self-compassion, and positive mental states.

The interventions mentioned above are valuable in improving specific aspects of hedonic well-being—either by reducing negative experiences or by improving pleasure and joy.

Enhancement of other positive variables

Flook et al. [ 32 ] had obtained evidence for a 12-week mindfulness-based Kindness Curriculum being effective in improving social competence, including pro-social behavior and emotion regulation, of pre-school children. It had also improved academic performance, tendency to delay gratification, and cognitive flexibility. In a longitudinal study, de Vibe et al. [ 38 ] reported that after a six-year follow-up, the participants who had undergone a 7-week abridged MBSR scored higher in well-being, mindfulness, and problem-focused coping that was a predictor of higher well-being. They had also revealed deteriorated avoidance-focused coping. The results were present even among the participants with low adherence to the regular practice of MBSR. Amutio et al. [ 37 ] have also described the effect of MBSR on well-being and related variables. At the end of the intervention period, participants in the experimental group scored significantly higher in mindfulness and relaxation. After a 10-month maintenance phase, their already reported positive outcomes were found to have increased even higher, particularly the scores on mindfulness, and all four dimensions of relaxation state—mindfulness, positive energy, transcendence, and relaxation. Bhayee et al. [ 46 ], using the app 'Calm', had studied the impact of an NtsMT on attention and well-being. The result suggested a moderate effect of mindfulness on attention and well-being while previous literature had a different say on its effect size. The reason shall be attributed to the delivery mode of the intervention, its duration, or both. Sorensen et al. [ 54 ] had introduced a novel intervention, Convergence , that was tested for its efficacy in comparison with an LKM-only group and a music-only group. The results indicated that all these three conditions improved mindfulness, self compassion, and well-being with small effect sizes. A study conducted by Huppert & Johnson [ 41 ] revealed high positive association between the time spent for mindfulness practice outside the intervention period and the amount of mindfulness and well-being. Other than that, between control and experimental groups, no significant differences were observed. The effect of RMT on compassion, stress, and mindfulness were assessed by Vich et al. [ 57 ]. Their study results outlined that RMT has a significant impact on self-compassion, stress, and mindfulness in the long run. RMT had an impact on compassion, and subjective happiness for a short time, but failed to sustain it over time. In a pilot randomized controlled trial, Champion et al. [ 47 ] had received the effect of the use of a mindfulness meditation app ‘Headspace’ on life satisfaction, stress, and resilience. Highest improvement was on 10 th session, that dropped moderately by the last and 30th session. Through two subsequent studies, Neff & Germer [ 51 ] obtained evidences for the impact of MSC on enhanced mindfulness, self-compassion and well-being.

MBIs as mindfulness-based positive psychology interventions (MPIs)

In the current systematic review, 21 papers were reviewed that described 22 studies on the impact of MBIs over positive human functioning, with prime importance given to eudaimonic well-being and secondary preference given to hedonic and other positive psychology variables. The latter was given secondary focus as hedonic well-being or the tendency to seek pleasure and avoid pain is mostly associated with clinical symptom reduction and temporary pleasurable experiences, rather than well-being and flourishing. Most of the MBIs reviewed were developed for specific needs not comprehensively focusing on either eudaimonia or hedonia and other positive psychology variables. Interventions administered among children were reported by three studies [ 32 , 40 , 41 ] and all these three have focused on a few specific positive psychology variables which cannot be attributed to an overall enhancement in eudaimonic or hedonic well-being. Three studies [ 48 , 49 , 50 ] have focused on a dimension of eudaimonic well-being—positive relationships. One of these is an adapted preventive intervention for adolescent substance use and problem behavior, and could not be considered as an MPI. The target population for six studies was college/university students [ 38 , 39 , 47 , 52 , 56 , 57 ]. One of these has chosen only distressed students and none of the studies focused entirely on well-being. Ten studies had recruited the general adult population through online or regular modes. Some studies advertised for volunteers as participants and some have recruited participants from institutions under different conditions. Most of the studies offered remunerations at various points. None of these studies employed interventions for enhancement of well-being with prime importance, and the positive impact of all of these MBIs was limited, focusing on specific aspects like self-compassion, mindfulness, or resilience. Hence, without ignoring the positive potential of these MBIs, it is required to point out the need for exploring positive outcomes of MBIs more extensively, and modify the existing interventions if required, to incorporate facilities to enhance positive outcomes.

Limitations

The review was restricted to three databases and manual search, and the possibility of unintentional exclusion of relevant articles indexed in other databases cannot be ignored. It is also possible that some of the excluded articles that primarily focus on clinical variables had reported the positive potentials of those clinical interventions. Though not high, there is a risk of bias in the cumulative result. And high heterogeneity of reviewed studies restricted the current research to opt for a systematic review rather than meta-analysis.

Conclusions

The current review has identified the major studies where MBIs were applied and its impact on positive human functioning assessed. The nature, pattern, duration, and focal area of interventions varied greatly and mostly centered around a few specific positive variables rather than overall well-being and flourishing. Application of MBIs for hedonic and other positive variables is found to be more frequent than the usage of MBIs for eudaimonic enhancement. This was not concluded from just the review of the final 21 articles, but from the entire process of finalizing those studies. This is consistent with the statement of Deci & Ryan [ 60 ] who had noted that the number of studies on hedonia greatly exceeds than that on eudaimonia. Hedonic well-being was closely associated with clinical symptom reduction instead of increment in the experience of perceived pleasure. Most of the MBIs applied with expected positive outcomes were context-specific or limited in the scope of applicability. The review was futile in finding any singularly positive-psychology oriented interventions, but a few of the interventions show powerful utility as an MBI that could enhance specific positive variables. Further empirical explorations shall reveal the potency of these MBIs as mindfulness-based positive psychology interventions. Modifications in the structure and functions to be more inclusive of contexts and populations would yield better positive outcomes of the existing MBIs. Also, MBIs that aimed at catering the needs of the recipients based on factors such as culture, ethnicity, and gender would result in highly effective MPIs. From the review, it could also be concluded that it is imperative to develop interventions with sole focus on enhancement of positive potentials, especially eudaimonic enhancement.

Study results point out that physical pleasures derived out of hedonia are not sufficient for the experience of well-being [ 61 , 62 , 63 ]. Keyes & Annas [ 64 ] pointed out the gulf between individuals with high hedonic well-being (48.5%) and their flourishing (18%). This explains the severe eudaimonic deficiency that contributes to the lack of flourishing. And in some other personal or social situations where hedonia can contribute little to a person’s well-being—such as chronic illnesses, physical or psychological pain, financial insecurity, childlessness, bereavement, or social/political unrest—eudaimonia is inevitable to maintain general well-being, happiness, contentment, and a sense of meaning and purpose in life. Eudaimonia apparently buffers against possible psychological harm also [ 64 ]. Hence it demands explorations in the direction of eudaimonic enhancement across different populations, cultures, and contexts. Unfortunately, few researches have addressed this issue so far and eudaimonic enhancement still remains a neglected area within applied positive psychology. Considering the paucity of MPIs exclusively for eudaimonic enhancement, it is recommended that immediate further actions are essential to develop, validate, and avail the same, among both clinical and non-clinical populations. In conclusion, the current study has reviewed the major studies where the MBIs are used for enhancement of eudaimonia, hedonia, and other positive psychology variables. It contributes to the existing scientific literature by pointing out the positive potentials of MBIs and the endless possibilities of empirical studies on the application of MPIs. Finally, the review emphasizes the need of future studies paying attention to the utilization of eudaimonic enhancement potential of MPIs along with the focus on enhancement of hedonic and other positive outcomes.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Mindfulness-Based Intervention

Positive Psychology Intervention

Mindfulness-Based Positive Psychology Intervention

Mindfulness Based Stress Reduction

Internet-delivered Acceptance and Commitment Therapy

Neurofeedback assisted technology supported mindfulness training

Electroencephalogram

Mindfulness-Based Relationship Enhancement

Mindfulness-Enhanced Strengthening Families Program

Mindful Self Compassion

Loving Kindness Meditation

Mindfulness Integrative Model

Relational Mindfulness Training

Positive Mindfulness Program

Dharma in Daily Life

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Joshua George Allen, John Romate & Eslavath Rajkumar

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Allen, J.G., Romate, J. & Rajkumar, E. Mindfulness-based positive psychology interventions: a systematic review. BMC Psychol 9 , 116 (2021). https://doi.org/10.1186/s40359-021-00618-2

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University of Oxford Mindfulness Research Centre

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Depression is a global health crisis affecting around one billion people worldwide

In response to the depression crisis, a global wellness industry worth around $6 trillion has burgeoned.

At Oxford, we have pioneered cognitive and mindfulness-based therapies to treat and prevent depression with demonstrated effectiveness, with our work published in peer review publications such as the BMJ, Lancet, JAMA Psychiatry and Clinical Psychological Science.

To help solve the global challenge of depression, we need to find ways to give more people access to effective treatments.

Our work focuses on preventing depression, promoting mental health and resourcing people to meet the challenges of the 21st century.

Depression is a common disorder that has enormous medical, social, economic and personal costs. It often starts early in life and runs a recurrent course. Treatment can be effective and includes anti-depressants and ‘talking therapies’ such as Cognitive Behavioural Therapy (CBT). But these treatments do not work for everyone. Crucially, antidepressants only work for as long as someone continues to take them. Research at Oxford University and partner institutions over the last decade has developed, tested and rolled-out new approaches to treating and preventing depression – giving those at risk, access to proven tools to help manage their condition long-term.

Mindfulness-Based Cognitive Therapy (MBCT) for Depression was first developed by Mark Williams, John Teasdale (Cambridge) and Zindel Segal (Toronto) to help people at risk for depression learn lifelong skills to stay well.  The approach teaches people a range of skills to prevent depression, including learning to view negative thoughts as passing mental events, rather than facts. “Cognitive behavioural therapy teaches people to challenge their negative thoughts but for people with recurrent depression this can be really hard,” explains Professor Willem Kuyken. “MCBT takes a slightly different approach. It encourages people to accept their thoughts, stand back from them, and realise they will pass.”

Numerous randomised controlled trials have shown that MCBT is effective, and more recent work conducted at Oxford has shown that the ability to decentre from negative thoughts and learn to be kind and self-compassionate, is critical to the success of the approach. Importantly, several trials have now shown that MBCT is an effective alternative to long-term use of antidepressants. 

Over the last ten years, the Oxford team have worked to embed MBCT for depression into policy and practice and ensure access to the therapy for millions of people around the world.  MCBT is now one of the recommended interventions in many international clinical guidelines including the USA and Canada. In England, patients have access to MCBT through the NHS Improving Access to Psychological Therapies (IAPT) programme, with evidence from these services suggesting that it helps people enhance their mental health and sustain their recovery from depression. 

Most recently our focus was the primary prevention of depression and the promotion of mental health in adolescence. That is to say, can we extend our work with adults to young people at a key stage of life to learn skills that develop their resilience, and reduce the chance of depression developing in the first place. This research was published and widely reported in 2022, and suggests that schools-based mindfulness training in 11-14 year olds does not improve the mental health of young people but does enhance teachers' mental health and school climate. More details about the project, including all the publications, can be found by visiting the following website  www.myriadproject.org

Mental health research is a relatively new but evolving field. An analogy with heart disease is instructive. Basic and applied science in the last fifty years has led to stepwise improvements not only in the prevention, treatment and rehabilitation of heart disease but also the promotion of heart health in the whole population. The same stepwise improvements are needed with mental health in the next fifty years.  Our vision is:

• A world without the devastating effects of depression
• Where people enjoy mental health and well-being and,
• Are resourced to meet the challenges of the 21st century.

We're working to realise this vision through research, training, teaching, and public engagement, see  here . 

OUR CURRENT RESEARCH 

Our group has  developed MBCT for a range of other clinical groups, people who are suicidal, who experience health anxiety and who have cardiovascular disease. We have also contributed to the development of mindfulness-based programs across the lifespan, for adults, for children and adolescents, and at different stages of life, such as the transition to becoming parents . We have also started to explore MBCT's acceptability and effectiveness in different settings, such as teachers working in schools and prisoners in the criminal justice system.

Our next challenge is to use a global health approach to enhancing mental health in the whole population. People learn foundational skills for life in MBCT that they can use not only to cope with the everyday strains and pressures that can lead to poor mental health, but also to enjoy greater well-being and  to flourish. More than this, they can learn foundational skills that are needed to face the major challenges in our contemporary world. To do this we need to develop and research how MBCT can be accessible, effective and cost-effective to a wider population and across the lifespan.

Throughout all our work we are interested in the following:

• Theory: How does mindfulness alleviate distress, build resilience and enable flourishing?
• Efficacy, effectiveness and cost-effectiveness: Is MBCT effective and cost-effective both in controlled trial and real-world conditions?
• Implementation: How can it best be implemented / scaled up?
• Lifespan: Can we consider how MBCT can play a role in primary prevention, inter-generational transmission,  secondary prevention and long-term recovery.

 How is our research funded?

Our work has been  supported by research grants from the National Institute for Health Research, Wellcome Trust, Medical Research Council, Mind and Life, Oxford Mindfulness Foundation, the University of Oxford and the Sir John Ritblat Family Foundation.  

Our work has also benefited from generous donations. If you could like to support our research you can make donations via this link . 

Our Masters of Studies in Mindfulness-based Cognitive Therapy

This two-year part-time Masters course offers experienced professionals from a range of backgrounds a unique opportunity to develop in-depth specialist knowledge and skills in mindfulness-based cognitive therapy (MBCT) curricula. Ou hope is that it will identify and resource the next generation of MBCT teachers, trainers and researchers.

The Oxford Mindfulness Centre

The Oxford Mindfulness Centre has been at the forefront of MBCT research, innovation, teaching and training since it was founded by Professor Mark Williams in 2008. Since 2014 it has been directed by Professor Willem Kuyken, the Sir John Ritblat Family Foundation Professor of Mindfulness and Psychological Science. It is a collaboration between the University of Oxford Psychiatry Department and the Oxford Mindfulness Foundation (OMF), a UK-registered charity. The  Oxford Mindfulness Foundation 's work includes using MBCT training curricula we have developed collaboratively to offer MBCT training and courses around the world. To date many hundreds of MBCT Teachers have been trained in Asia, Europe and South America, and thousands of people have participated in MBCT courses. Increasingly the Foundation is building international partnerships to further its important work.

Resources Page

• Where do I find the best mindfulness and mindfulness-based cognitive therapy (MBCT) book/website/app?
• What is some of the most important research?
• I'd like to learn more about mindfulness/MBCT, but I don't know where to start.

This listing of MBCT and mindfulness key resources is intended to signpost to books, research articles, websites, podcasts and other mindfulness resources. It is regularly updated, but please note it focuses on evidence-based mindfulness programs, in particular MBCT, and is not intended to be comprehensive. It is updated every few months as new resources become available.

The resources can be downloaded here .

Oxford Mindfulness Research Group

Willem Kuyken

Ritblat Professor of Mindfulness and Psychological Science

Jesus Montero Marin

Senior Researcher

Mindfulness Researcher, Teacher and Trainer - Professor Emeritus of Psychology, University of Kentucky

Alena Laskova

Kearnan Myall

DPhil Student

Shannon Maloney

Postdoctoral Researcher

Selected publications

Piera Pi-Sunyer B. et al, (2024)

Montero-Marin J. et al, (2024)

Maloney S. et al, (2024)

Journal article

Braun SS. et al, (2024), J Sch Psychol, 104

Dunning DL. et al, (2024), Cogn Emot, 1 - 13

Ahmed SP. et al, (2024), Dev Sci

Maloney S. et al, (2024), Behaviour Research and Therapy

Maloney S. et al, (2024), BMJ Mental Health, 27, e300955 - e300955

Knight R. et al, (2023)

Böttcher L. et al, (2023), BMC Psychiatry, 23

Maloney S. et al, (2023), Psychother Res, 1 - 12

Hinze V. et al, (2023), J Am Acad Child Adolesc Psychiatry

García-Campayo J. et al, (2023), Assessment

Bogaert L. et al, (2023), Behav Res Ther, 169

Montero-Marin J. et al, (2023), JAMA Netw Open, 6

Dunn BD. et al, (2023), EClinicalMedicine, 61

Sanders A. et al, (2023), Mindfulness, 14, 1718 - 1734

Bignardi G. et al, (2023)

Montero-Marin J. et al, (2023), J Am Acad Child Adolesc Psychiatry

Mansfield KL. et al, (2023), JCPP Advances

Böttcher L. et al, (2023)

van der Velden AM. et al, (2023), Biol Psychiatry, 93, 233 - 242

Floyd E. et al, (2023), Global Advances in Integrative Medicine and Health, 12, 275361302211499 - 275361302211499

Leung JT. et al, (2023), Infant Child Dev, 32

Dunn BD. et al, (2023), Mindfulness, 14, 113 - 127

Conference paper

Cohen ZD. et al, (2023), Clin Psychol Sci, 11, 59 - 76

Myall K. et al, (2023), Br J Sports Med, 57, 99 - 108

Dunn BD. et al, (2023), Mindfulness

Garcia-Toro M. et al, (2023), Front Psychol, 14

Siwik CJ. et al, (2023), Global Advances in Integrative Medicine and Health, 12, 275361302211442 - 275361302211442

Maloney S. et al, (2023), Mindfulness (N Y), 14, 2155 - 2171

Berta-Otero T. et al, (2022), Int J Environ Res Public Health, 20

Alsayednasser B. et al, (2022), Behaviour Research and Therapy, 104185 - 104185

Tudor K. et al, (2022), Prev Sci, 23, 934 - 953

Kuyken W. et al, (2022), Evid Based Ment Health

Montero-Marin J. et al, (2022), Evid Based Ment Health, 25, 117 - 124

Montero-Marin J. et al, (2022)

Dunning D. et al, (2022), Evid Based Ment Health

Williams JMG. et al, (2022), Mindfulness (N Y), 1 - 14

Kirschner H. et al, (2022), Mindfulness, 13, 928 - 941

Hitchcock C. et al, (2022), Behav Res Ther, 151

Bennett MP. et al, (2022), BMJ Open, 12

Knight R. et al, (2022)

Loucks EB. et al, (2022), Global Advances in Health and Medicine, 11, 216495612110688 - 216495612110688

Ford T. et al, (2021), J Am Acad Child Adolesc Psychiatry, 60, 1467 - 1478

Myall K. et al, (2021), Int J Environ Res Public Health, 18

Schuling R. et al, (2021), Mindfulness, 12, 2196 - 2206

Breedvelt JJF. et al, (2021), JAMA Psychiatry, 78, 868 - 875

Kirschner H. et al, (2021)

Medlicott E. et al, (2021), Int J Environ Res Public Health, 18

Hitchcock C. et al, (2021)

Bennett MP. et al, (2021), Transl Psychiatry, 11

Cohen Z. et al, (2021), Biological Psychiatry, 89, S36 - S37

Strauss C. et al, (2021), Int J Clin Health Psychol, 21

Montero-Marin J. et al, (2021), Trials, 22

Chaplin TM. et al, (2021), Res Child Adolesc Psychopathol

Griffith GM. et al, (2021), Global Advances In Health and Medicine, 10

Montero-Marin J. et al, (2021), Journal of Educational Psychology

Baer R. et al, (2021), Mindfulness (N Y), 12, 763 - 774

McKinnon A. et al, (2020), J Affect Disord, 276, 212 - 219

Yasinski C. et al, (2020), Psychother Res, 30, 983 - 997

Ahmed S. et al, (2020), J Adolesc, 84, 56 - 68

Schuling R. et al, (2020), J Affect Disord, 273, 265 - 273

Schweizer S. et al, (2020)

Ford T. et al, (2020), Br J Psychiatry, 216, 175 - 177

Montero-Marin J. et al, (2020), Int J Environ Res Public Health, 17

Tickell A. et al, (2020), BMJ Open, 10

Breedvelt JJF. et al, (2020), BMJ Open, 10

Andrews LA. et al, (2020), J Consult Clin Psychol, 88, 106 - 118

Alsubaie M. et al, (2020), Mindfulness, 11, 30 - 50

Crane PhD C. et al, (2020), Glob Adv Health Med, 9

S Crane R. et al, (2020), Glob Adv Health Med, 9

Gu J. et al, (2020), Assessment, 27, 3 - 20

Gu J. et al, (2020), Assessment, 27, 149 - 163

Rycroft-Malone J. et al, (2019), BMJ Open, 9

Dunn BD. et al, (2019), Behav Res Ther, 120

Baer R., (2019), Curr Opin Psychol, 28, 42 - 48

Baer R. et al, (2019), Clin Psychol Rev, 71, 101 - 114

Hitchcock C. et al, (2019), J Exp Psychol Gen

Dunning DL. et al, (2019), J Child Psychol Psychiatry, 60, 244 - 258

TICKELL A. et al, (2019), Mindfulness

Kirschner H. et al, (2019), Clinical Psychological Science

Dunn BD. et al, (2019), Pilot Feasibility Stud, 5

Gjelsvik B. et al, (2018), PSYCHOLOGIST, 31, 22 - 25

crane R. and Kuyken W., (2018)

Crane RS. and Kuyken W., (2018), Curr Opin Psychol, 28, 6 - 10

Black M. et al, (2018), BMJ Open, 8

Racey DN. et al, (2018), Mindfulness, 9

Wilde S. et al, (2018), Mindfulness

Karl A. et al, (2018), Clin Psychol Psychother

Hitchcock C. et al, (2018), Clin Psychol Sci, 6, 315 - 324

Richards SH. et al, (2018), Health Technol Assess, 22, 1 - 220

Strauss C. et al, (2018), Trials, 19

Richards SH. et al, (2018), Trials, 19

Psychogiou L. et al, (2018), Br J Dev Psychol

Racey DN. et al, (2018), Mindfulness (N Y), 9, 1063 - 1075

Gjelsvik B. et al, (2018), Cognit Ther Res, 42, 782 - 793

Montero-Marin J. et al, (2018), Front Psychol, 9

Kirschner H. et al, (2017), PSYCHOPHYSIOLOGY, 54, S71 - S71

Richards DA. et al, (2017), Health technology assessment (Winchester, England), 21, 1 - 366

Sahdra BK. et al, (2017), European Journal of Personality, 31, 347 - 365

Alsubaie M. et al, (2017), Clinical psychology review, 55, 74 - 91

Kuyken W. et al, (2017), Trials, 18

Rycroft-Malone J. et al, (2017)

Crane RS. et al, (2017), Psychological medicine, 47, 990 - 999

Mitchell PM. et al, (2017), BMC Psychiatry, 17

Related research themes

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Simple Serenity

Mindfulness-Based Healing Therapy

Case Study: A Mindfulness Based Approach to Stress Reduction

Mindfulness is a practice individuals and groups can do on a day-to-day basis. It can enable people to change the way they think and feel about their experiences, especially stressful experiences. As a mind-body approach, it can increase one’s ability to manage difficult situations and make wise choices.

A growing body of evidence has found that when people intentionally practice being mindful they feel less stressed, anxious and depressed. Research also shows positive effects on several aspects of whole-person health, including the mind, the brain, the body, and behavior, as well as a person’s relationships with others.

Meet Mr. and Mrs. X

A husband and wife, both in their sixties and newly retired, wanted to incorporate a mindful practice into their daily lives, manage their stress more effectively, and work on their personal roadblocks. To protect the privacy of the couple, I’ll refer to the husband and wife as Mr. and Mrs. X.

The Objective

Married for over forty years, Mr. and Mrs. X have a strong and healthy relationship, yet each recognized the opportunity for improvement, particularly in the areas of nutrition and symptomatic behaviors. Of paramount importance was not only self-improvement but the ability to listen deeply, offering the possibility of being more empathetic and nurturing toward one another. Recognizing they needed help to achieve these goals, the couple researched different styles of therapy. Eventually choosing mindfulness-based education and coaching, they contacted The Center for Mindfulness at the University of Massachusetts Medical School, who referred them to me as one of the few certified MBSR teachers in the Pacific Northwest.

The Intervention: Mindfulness-Based Stress Reduction

After an introductory meeting to discuss the preferred course of action with the couple, I proposed a personalized 8-week mindfulness-based stress reduction program. This was eagerly accepted and our work together began. Over the duration of the program, we experienced various mindful meditations, explored mindfulness-based skills and practices, and implemented home assignments, resulting in deep self-discovery and meaningful discussions. The skills learned allowed them to bring a fresh perspective to their personal areas of challenge, resulting in self-discovery and healing.

The Outcome

Upon completion of their personalized program, the couple reported general reduced stress, the ability to be fully present non-judgmentally and open to experience, accepting things as they are, living in peace, serenity, and compassion. They no longer allow themselves to be swept up in life’s highs and lows, as best they can, moment to moment. Although the 8-week program has ended, Mr. and Mrs. X have decided to continue working with me to further their practice of mindful living.

Mr. and Mrs. X learned to deal gently, kindly and patiently with themselves and each other. Rather than judging, they learned to open their hearts to truly listen to and understand each other’s experience. The overarching goal was to support one another’s values and needs, and the couple feels they more than achieved this outcome. Putting my heart and soul into this opportunity, I did some of my best work with this couple. The results surpassed my highest expectation and witnessing their transformation is encouraging, inspirational, and beautiful.

Testimonial

“Lorrie Jones is an extraordinarily competent and effective mindfulness-based stress reduction teacher and therapist. Lorrie is also an exceptionally gifted mindfulness writer.”  

—Mr. and Mrs. X

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Mindfulness-based interventions: an overall review

Dexing zhang.

JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China

Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China

Eric K P Lee

Eva c w mak, samuel y s wong, associated data.

There are no new data associated with this article.

Introduction

This is an overall review on mindfulness-based interventions (MBIs).

Sources of data

We identified studies in PubMed, EMBASE, CINAHL, PsycINFO, AMED, Web of Science and Google Scholar using keywords including ‘mindfulness’, ‘meditation’, and ‘review’, ‘meta-analysis’ or their variations.

Areas of agreement

MBIs are effective for improving many biopsychosocial conditions, including depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. It is found to be beneficial in the healthcare settings, in schools and workplace but further research is warranted to look into its efficacy on different problems. MBIs are relatively safe, but ethical aspects should be considered. Mechanisms are suggested in both empirical and neurophysiological findings. Cost-effectiveness is found in treating some health conditions.

Areas of controversy

Inconclusive or only preliminary evidence on the effects of MBIs on PTSD, ADHD, ASD, eating disorders, loneliness and physical symptoms of cardiovascular diseases, diabetes, and respiratory conditions. Furthermore, some beneficial effects are not confirmed in subgroup populations. Cost-effectiveness is yet to confirm for many health conditions and populations.

Growing points

Many mindfulness systematic reviews and meta-analyses indicate low quality of included studies, hence high-quality studies with adequate sample size and longer follow-up period are needed.

Areas timely for developing research

More research is needed on online mindfulness trainings and interventions to improve biopsychosocial health during the COVID-19 pandemic; Deeper understanding of the mechanisms of MBIs integrating both empirical and neurophysiological findings; Long-term compliance and effects of MBIs; and development of mindfulness plus (mindfulness+) or personalized mindfulness programs to elevate the effectiveness for different purposes.

Mindfulness and mindfulness-based interventions

Mindfulness is a moment-by-moment awareness of thoughts, feelings, bodily sensations and surrounding environment. Being mindful is related to be open, nonjudgmental, friendly, curious, accepting, compassionate and kind. 1 Mindfulness practices aim to cultivate mindfulness state. These practices can be formal (e.g. breathing, sitting, walking, body scan) or informal (e.g. mindfulness in everyday life). Many mindfulness-based intervention (MBI) programmes have been established. Among all the MBIs, mindfulness-based stress reduction (MBSR), which was launched by Jon Kabat-Zinn in 1979, 2 and mindfulness-based cognitive therapy (MBCT) by Segal, Teasdale and Williams based on MBSR, 3 , 4 are the two most widely adopted MBIs. These two programmes include eight weekly mindfulness sessions with one-day retreat.

Mindfulness is rooted in Buddhist traditions. However, it has become popular in recent years among various secular populations in healthcare, educational and workplace settings: from pre-school children to older adults across the world. Publications on mindfulness have increased dramatically in the recent decade. The publications on mindfulness is starting to be more comparable to publications on cognitive behavioural therapy (CBT), which is one of the most widely used psychotherapies ( Fig. 1 ).

Comparison on number of publications: mindfulness vs. CBT trials (by August 2020) [Note: Search terms included (‘mindful* or meditate*’ AND ‘trial or random or random* control* trial*’); (‘cognitive behavioural therapy or cognitive behavioural therapy or CBT’ AND ‘trial or random or random* control* trial*’) in Title; Databases included MEDLINE, EMBASE and PsycINFO.]

Methods used for identifying relevant evidence

Literature in English was searched in MEDLINE, EMBASE, CINAHL, PsycInfo, AMED, Web of Science and Google Scholar using keywords including ‘mindfulness’, ‘meditation’ and ‘review’, ‘meta-analysis’ or their variations, with no restrictions on the year of publication. The search was conducted in July 2020. In choosing evidence, these general principals were applied: (i) published in more recent years if similar reviews were identified; (ii) included randomized controlled trials or meta-analysis in the review; (iii) presented with more conclusive conclusions. Literature with other types of study design (e.g. randomized controlled trials, cohorts, cross-sectional studies) were also manually searched and included when no systematic review was found or when considered as appropriate. However, while it was intent to include all important literature in a certain area, the review might not exhaust all relevant literature but had only selected key references of interest that we thought to be most pertinent and insightful for a specific topic.

Effects on mental health

MBIs have been shown to be efficacious in improving some of the common mental health problems. 5

Depression and anxiety

For depression and anxiety, the efficacy of MBIs is sufficiently confirmed with meta-analyses demonstrating moderate to strong effect sizes for the reduction of the two conditions. 6–8 The effects were also applicable during pregnancy, where a systematic review showed that MBIs helped reducing perinatal anxiety of moderate to large magnitude; however, the effects were less consistent in terms of reducing perinatal depression. 9 The trending web-based interventions on mindfulness have also shown effectiveness in reducing depression and anxiety among people diagnosed with anxiety disorders as well. 10 It was unclear, however, whether the benefits of mindfulness practices as a stand-alone intervention still exist, as it is difficult to dismantle the effects from social interaction and psychoeducation, which are the other components integrated in many MBIs (e.g. group MBCT), from standalone mindfulness practices. Therefore, a recent meta-analyses 11 of 18 eligible studies investigated the gap, and has demonstrated that even mindfulness practice itself (e.g. breathing space, body scan, sitting meditation, soundscan) had small to medium effects on both anxiety (SMD = 0.39; CI: 0.22, 0.56; PI: 0.07, 0.70; P  < .001, I 2  = 18.90%) and depression (SMD = 0.41; CI: 0.19, 0.64; PI: −0.05, 0.88; P  < .001; I 2  = 33.43%).

Current evidence overall supports a moderate effect of MBIs on reducing stress; however, more robust studies are needed to make clear conclusions among different populations. A meta-analysis of five randomized control trials tested the effects of MBIs on cortisol levels, a stress-mediated hormone, and found that there may be a beneficial effect in healthy adult populations. 12 Yet, the overall effect size was moderately low ( g  = 0.41; P  = 0.025). 12 On the other hand, another meta-analysis indicated that there was a significant, medium effect of meditation interventions on cortisol levels, but the effect was only present for at-risk samples such as those living in stressful life situations. 13 There are also studies done among specific populations such as tertiary education students 14 and older adults, 15 showing inconclusive results. Among tertiary education students, the effect sizes of interventions for stress were moderate ( g  = 0.42, 95% CI: 0.27–0.57), but most studies were of poor quality. 14 Among older adults, no clear evidence was found that MBIs can reduce the perception of stress. 15

The current evidence on the effects of MBIs on insomnia and sleep disturbance is promising. A meta-analysis concluded that MBIs are effective in improving symptoms of insomnia and sleep quality when compared to attention/education and waitlist control with medium to large effects ( g  = 0.67, 95% confidence interval [CI] = 0.30–1.05) and that the effects seem to endured at 3 months postintervention ( g  = 1.06, 95% CI = 0.48–1.64). 16 Several other meta-analyses also found similar results, which all showed significant improvement in insomnia or sleep quality as measured by the Pittsburgh Sleep Quality Index. 17–19

Eating disorders

Current studies provided preliminary evidence on the potential effects of MBIs on eating disorders (EDs). One systematic review and meta-analysis showed a within-condition effect of MBIs on ED symptoms, emotional eating, negative affect and body dissatisfaction, and on the body mass index (BMI) in anorectic and bulimic participants relative to pre-assessment. 20 Another systematic review and meta-analysis also found that MBIs may help reducing body image concern and negative affect, while promoting body appreciation. 21 Both authors concluded that more rigorous studies are needed before the efficacy of MBIs on EDs can be confirmed. 20 , 21

Literature supports the efficacy of MBIs in both substance and behavioural addictions. A systematic review of 54 randomised controlled trials found that MBIs were successful in the reduction of dependence, craving and other symptoms related to addiction, and the improvement of mood state and emotion dysregulation. 22 Two other meta-analytic results also revealed significant small-to-large effects of MBIs in reducing levels of perceived craving, 23 , 24 severity of stress, 23 , 24 frequency and severity of substance misuse, 23 anxiety and depressive symptoms, 24 negative affectivity, 24 and post-traumatic symptoms 24 for the treatment of substance misuse. Although the effectiveness is promising, more research is needed especially on longer follow-up assessments and among diverse populations.

It seems that MBIs have potential benefits for people with psychosis, but further research is warranted. 25 A systematic review and meta-analysis on 434 patients found short-term moderate evidence of MBIs on total psychotic symptoms, positive symptoms, hospitalization rates, duration of hospitalization, and mindfulness as short-term effects and total psychotic symptoms and duration of hospitalization as long-term effects in patients with psychosis. 26 Another systematic review also confirmed that MBIs are feasible for individuals with psychosis and it could provide a number of significant benefits over routine care such as improving negative symptoms and measures of functioning. 27 Future large trials adopting randomization procedure are suggested to gain greater insight into the mechanisms and long-term effectiveness of MBIs among people with psychosis.

Post-traumatic stress disorder

MBIs among post-traumatic stress disorder (PTSD)-diagnosed participants were less conclusive. A systematic review and meta-analysis of 10 trials on meditation interventions have shown that the effects for PTSD were positive but not statistically significant. 28 The variety of meditation intervention types, the short follow-up times and the quality of studies limited the analyses. 28 Other systematic reviews reported similar findings, where they reported MBIs such as mindfulness, yoga and relaxation studies maybe useful for the mind–body treatments for PTSD but many of the trials suffered from methodologic weaknesses or were of low to moderate methodological rigor. 29 , 30 Further high-quality studies are needed on MBIs among PTSD-diagnosed participants in order to increase confidence in its effectiveness.

Attention-deficit hyperactivity disorder

There is a need for further research before determining the effectiveness of MBIs on attention-deficit hyperactivity disorder (ADHD) despite current studies showed that it can be a promising intervention. A systematic review and meta-analysis has found statistically significant effect of MBIs in decreasing the severity of ADHD core symptoms such as inattention, hyperactivity or impulsivity (children/adolescents: Hedge’s g  = −0.44, 95% CI −0.69 to −0.19, I 2 0%; adults: Hedge’s g  = −0.66, 95% CI –1.21 to −0.11, I 2 81.81%). 31 However, the authors concluded that there is insufficient methodologically sound evidence to support the effectiveness due to limited number of studies, heterogeneity across studies and high risk of bias. 31 Similar results and conclusions were also noted in several other systematic reviews. 32–34

Autism spectrum disorders

Current literature on MBIs for people with autism spectrum disorders (ASD) or their carers is very limited. A systematic review done in 2017 analysed 16 eligible studies but definitive recommendations could not be made on the effects of MBIs for people with ASD or their carers. 35 This was because those studies included very diverse age groups and outcome measures, including behavioural, social and psychological symptoms, as well as the subjective well-being of children and adults with ASD and their parents. 35 Overall, there may be some potential benefits of MBIs among people with ASD, these include: reducing anxiety, 35 , 36 thought problems, 35 , 36 rumination, 35 aggression, 36 parental stress 37 , and increasing subjective well-being 38 as well as parental psychological wellbeing. 37

The current available evidence to support MBIs on cognition is weak. A systematic review conducted in older adults with mild cognitive impairment found that MBIs improved participant’s cognitive function and everyday activities functioning. 39 However, the available studies had small sample sizes, lack of control comparison and lack of follow-up to understand the effects on preventing progression of dementia. 39 Further high-quality trials and on different populations are required to confirm the effectiveness of the benefits of MBIs on cognitive function.

Effects on physical health

MBIs can provide positive effects on physical health and evidence is strong regarding benefits of MBIs on the psychological symptoms among people with chronic diseases.

The evidence of benefits of MBIs on pain is abundant among different populations. 40 , 41 A systematic review and meta-analysis of 30 RCTs on chronic pain conducted in 2017 showed improvement on chronic pain management after mindfulness meditation intervention. 40 The percent change of the mean in pain for intervention subjects was −0.19% (SD, 0.91; min, −0.48; max, 0.10), which was significantly higher than the control groups (−0.08% (SD, 0.74; min, −0.35; max, 0.11)). 40 A network meta-analysis found MBSR is effective for chronic pain, and the effects are not significantly different between MBSR and CBT; though more studies are needed to confirm this. 41 Furthermore, for the effects of brief MBIs with a total contact time of less than 1.5 hours, current evidence is inadequate to confirm the effectiveness on acute and chronic pain. 42

Hypertension and cardiovascular diseases

A few systematic reviews and meta-analyses suggested that MBIs can reduce blood pressure (BP). 43–45 A systematic review and meta-analysis of five studies on MBSR showed reduction on systolic and diastolic blood pressure in people with hypertension or elevated blood pressure. However, most of the studies were related to clinical blood pressure only and evidence on ambulatory blood pressure is needed. 43 A systematic review among people with non-communicable diseases found systolic BP was reduced after the eight-week MBSR (−6.90 mmHg [95% CI: −10.82, −2.97]), followed by the 12-week breathing awareness meditation (−4.10 mmHg [95% CI: −7.54, −0.66]), and eight-week mindfulness-based intervention (−2.69 mmHg [95% CI: −3.90, −1.49]) and diastolic BP was reduced after eight-week MBSR (−2.45 mmHg [95% CI: −3.74, −1.17]) and the eight-week MBI (−2.24 mmHg [95% CI: −3.22, −1.26]). 44 Another systematic review among patients with CVD in 2020 showed benefits on systolic BP ( d +  = 0.89, 95% CI = 0.26, 1.51) and psychological symptoms ( d + s = 0.49–0.64), but not diastolic BP. 45 Another systematic review by Zou evaluated the effect of mindful exercises for patients after stroke showed significantly improvement on the sensorimotor function on lower limb (SDM = 0.79; 95% CI, 0.43–1.15; I 2  = 62.67%) and upper limb (SDM = 0.7; 95% CI, 0.39–1.01; I 2  = 32.36%). 46 Further studies can assess gait speed, leg strength, aerobic endurance, motor function, cognitive function and gait parameters.

Weight control and obesity

Overweight and obesity are a significant health risk factor leading to tremendous disease burden due to the associated comorbidities. 47 Mindful eating is an effective intervention for weight control, especially among people with binge eating or emotional eating tendency. Mindful eating might have longer-term effects when comparing to conventional diet programmes, which involves limiting energy intake and restricting food choices, because mindful eating tends to be more sustainable and also deal with emotional problems that may influence unhealthy diet. 48–52 A systematic review and meta-analysis in 2019 evaluated ten mindful eating and weight control studies, and found significant weight reduction after mindful eating program when compared with control groups (−0.348 kg, 95% CI: −0.591 to −0.105). 53 Furthermore, effects of MBIs were equal to conventional diet programmes. 53 However, limitations were found in the studies, such as short duration and biased samples (unbalanced sex ratio, source and place of living). Hence, further studies with longer duration and modifications of subject selection could be beneficial to evaluate long-term improvement among different populations.

The current evidence to support the effect of MBIs on the physiological outcomes of diabetes is inconclusive. One systematic review found mixed results on the effectiveness of MBIs for physiological outcomes (glycaemic control and blood pressure) on both types 1 and 2 diabetes patients. 54 Another systematic review and meta-analysis found that meditative movements significantly improved the glycaemic control including fasting blood glucose, glycated haemoglobin (HbA1c) and postprandial blood glucose in type 2 diabetes mellitus (T2DM) patients. 55 Nonetheless, the authors noted it is difficult to conclude the extent to which MBIs are effective because of the small sample size, short duration and diverse delivery methods within the published studies. 55 Apart from glycaemic control, systematic reviews also found improvement in psychological symptoms such as anxiety, 54 distress symptoms, 54 , 56 depression 54 , 57 and quality of life. 57 Further research addressing the limitations is necessary to gauge the efficacy of MBIs for diabetes.

There may be some benefits of MBIs on the physical health outcomes in cancer patients especially on cancer-related fatigue and pain, besides psychological benefits. 58 , 59 A systematic review and meta-analysis found that MBIs led to a statistically significant reduction in cancer-related fatigue (CRF) score among cancer patients (SMD = -0.51, 95%CI [−0.81–0.20]), 59 especially among lung cancer patients. 60 Apart from CRF, a range of other outcomes such as improvements in sleep disturbances, pain and other psychological symptoms including anxiety, depression, fear of cancer recurrence were also found in another systematic review and meta-analysis. 61 Overall, although MBIs appeared effective in reducing CRF and other symptoms, further high-quality studies are still required to provide additional insights and to confirm the existing evidence.

Respiratory health (COPD, asthma, etc.)

The effectiveness of MBIs on respiratory health remained unclear. A systematic review and meta-analysis of 16 studies found that meditative movement may have the potential to enhance lung function and physical activity in Chronic obstructive pulmonary disease (COPD) patients. 62 When compared to nonexercised group, the intervention enhanced the 6-minute walking distance (3 months: mean difference [MD] = 25.40 m, 95% CI: 16.25–34.54; 6 months: MD = 35.75 m, 95% CI: 22.23–49.27), as well as functions on forced expiratory volume in 1 s (FEV 1 ) (3 months: MD = 0.1 L, 95% CI: 0.02–0.18; 6 months: MD = 0.18 L, 95% CI: 0.1–0.26). 62 However, taking into considerations of the limitations of the studies such as small sample sizes, inconsistency in study quality and the diverse style of meditative movement in studies, the authors noted that further trials are needed to substantiate the findings. 62 Other systematic reviews and meta-analyses on COPD 65 and asthma 63 also concluded that further high-quality trials are needed to confirm the effectiveness of MBIs on respiratory health. 63 , 64

Effects on social health and prosocial behaviours

There is evidence supporting effects of MBIs on social health and prosocial behaviours (i.e. voluntary behaviour intended to benefit another). 65 , 66 A systematic review found medium effects on prosocial behaviours for both correlational and intervention studies, and the effects are similar to known and unknown others. 65 The results suggest that mindfulness fosters ethical and cooperative behaviour across a range of interpersonal contexts and may reduce intergroup biases. 65 Another recent review with 29 studies also find similar results with small to medium effect sizes, suggesting MBIs reliably improve compassionate helping and reduces prejudice and retaliation. 66 Furthermore, MBIs can effectively reduce anger, 67 violence 68 and aggression. 69 It also may help improve social and ecological sustainability, by improving individuals’ subjective well-being and benign connection with others, the society and the nature. 70

Loneliness and social isolation are an increasing public health concern, especially during COVID-19 and for older adults. Some preliminary studies indicated that mindfulness training might have positive effect in mitigating loneliness. 71–74 A preliminary study showed MBSR effectively reduced loneliness in older adults. 71 Another study found positive effect on mitigating the loneliness of women with HIV. 72 A study among Chinese college students found a positive relationship between mindfulness and loneliness reduction. 73 Lindsay et al. raised that mindfulness both reduced loneliness and increased social interactions in daily life compared with an active control program, in the experiment of smartphone-based mindfulness training. 74

Mindfulness in different settings

Mindfulness among professionals in healthcare settings.

Mindfulness has been adopted as a stress management tool for healthcare professionals, with a medium effect size was found ( r  = 0.342, CI = 0.202–0.468). 75 Systematic reviews and meta-analyses have shown the promising effects on the other psychological indicators among healthcare professionals and students, e.g. reducing depression and burnout and improving emotional resilience. 76 , 77 However, both benefits and challenges (time limitations and feasibility) were perceived at the same time, 78 and there are insufficient studies on indirect outcomes of MBIs among healthcare professionals, e.g. how it may influence professional-patient communication, relationship and patient outcomes.

Mindfulness in schools

Mindfulness programmes in schools are increasingly popular. Many different school mindfulness programmes (e.g. ‘.b’, mindful schools, well and resilience program) have been implemented across the world. 79 , 80 These programmes can target at students, teachers, and even parents or caregivers. 81 Recent systematic reviews found MBIs hold promises in particular in improving resilience to stress, cognitive performance such as attention, and emotional problems in children and youths. 82 , 83 The reviews showed a significant effect for resilience in regards to well-being, positive and constructive emotions or affect, social skills and positive relationships, self-concept and self-esteem. The effects (effect size = 0.36–0.80) are comparable or better than the effects (overall effect size = 0.30) of school-based social and emotional learning programs as revealed in the meta-analysis. 84 It is promising in applying MBIs as a life skill within pre-, elementary, middle or high schools. Students might be benefited from 90-min mindfulness practice per week (i.e. 18 minutes on average per day). 85 In building up mindful schools, a whole school approach is valuable to integrate mindfulness through the curriculum, professional development of teachers, leadership practice and across the learning environment. 86

Mindfulness in workplace

A systematic review on 58 592 adults from nonclinical samples showed that trait mindfulness was positively associated with confidence, job satisfaction, performance and interpersonal relations, and negatively associated with burnout and work withdrawal. 87 A recent systematic review on 56 randomized controlled trials shows that MBIs are beneficial to employees in reducing stress, burnout, mental distress and somatic complaints, while improving mindfulness, well-being, compassion and job satisfaction—all with small to large effect sizes ranging from Hedge’s g  = 0.32–0.77, but effects on work engagement and productivity were limited by low number of studies. 88

Cost-effectiveness of MBIs

MBIs are likely to be cost-effective and value for money as it can be provided in group format or as self-help interventions, 89 and it can also be integrated into educational programmes for clinicians, educationalists and other professionals to directly and indirectly benefit themselves, students, their clients and people around them. 90 While the benefits are almost equal to cognitive behavioural interventions, mindfulness may require less professional training and take less time for both workers and clients to master, and they are probably less expensive to provide. 91 For example, studies showed that the training cost for teachers in a mindfulness training program ranged from US$515 to US$1850 per teacher depending on the number of teachers being trained and the ancillary and opportunity costs. 92 However, more studies are needed to confirm their cost-effectiveness. Preliminary evidence support its cost-effectiveness, 93 including but not limited to pain in breast cancer, 94 fibromyalgia, 95 low back pain 96 and caregiver training. 97 It is also a cost-saving treatment for improving quality of life for distressed cancer patients using both online or face-to-face MBCT. 98 However, uncertainties existed in workplace, 99 and yet it needs cost-effectiveness studies on many other health problems aswell.

Compliance of MBIs

Non-compliance is a barrier to learning mindfulness 100 and research shows that the drop-out rate can reach 25% or higher. 101 , 102 Inconsistent findings were shown in previous studies regarding who might or might not comply with MBIs. Although in general, women, those with higher openness to experience, higher resistance to change and severer symptoms showed higher levels of compliance. 103 , 104 The relationship between participants’ compliance and intervention outcomes is inconsistent, ranging from no correlation to a positive correlation, 105 although one recent systematic review based on 28 studies found a small but significant association between participants’ self-reported home practice and intervention outcomes ( r  = 0.26, 95% CI: 0.19–0.34). 106 In terms of factors associated with better compliance, a good natural setting is found to be important, especially for beginners. 100 And some researchers suggested to identify meditation exercises that can balance optimizing effectiveness and enhancing adherence to strengthen the compliance to MBIs. 107 It still needs more research to understand who might comply with and benefit from which type of MBIs the most, and to look into factors and strategies enhancing compliance.

Mechanisms of MBIs

Studies suggested that the mechanisms of MBIs include changes in mindfulness, rumination, worry, self-regulation, compassion or meta-awareness, which predicted or mediated the treatment effects, which are theoretically predicted mechanisms of MBIs. 108–111 Preliminary results also suggested alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect, can be part of the mechanisms. 108 Recently, the mindfulness-to-meaning (MMT) approach has also been recognized as providing a theoretical framework to investigate specific mindfulness components and their contributions to the positive health outcomes. 112 , 113 In this approach, the iterative cycle of appraisal, decentering and metacognition would lead to positive reappraisals of broader contexts that extinguish negative affect and promote positive effects and eudaimonic meaning in life. 112 , 113 Yet, there are still many unknowns regarding the mechanisms ofMBIs.

Neurophysiological findings

The changes on brain and biomarkers of immune function and stress might have provided neurophysiological basis for explaining the positive effects of MBIs. Systematic reviews have consistently found effects of MBIs on brain activity that involves in processing self-relevant information, self-regulation, focused problem-solving, adaptive behaviour and interoception, among both healthy populations and patient groups. 114–119 Eight brain regions key to meta-awareness (frontopolar cortex), body awareness (sensory cortices and insular), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication (superior longitudinal fasciculus; corpus callosum) consistently altered with a medium effect size after mindfulness practices. 118 In expert meditators, both functional and structural brain modifications have been induced, especially in areas involved in self-referential processes such as self-awareness and self-regulation, though not enough evidence suggests structural brain modifications in short-term meditators. 114 Among people with major depressive disorders, MBIs have also modulatory effects on several brain regions (e.g. the prefrontal cortex, the basal ganglia, the anterior and posterior cingulate cortices and the parietal cortex). 115 Another systematic review on 78 functional neuroimaging (fMRI and PET) studies of meditation found patterns of brain activation and deactivation for common styles of meditation (focused attention, mantra recitation, open monitoring and compassion/loving-kindness), with medium effects for both activations ( d  = 0.59) and deactivations ( d  = −0.74), suggesting potential practical significance. 116 The systematic review on EEG results suggested that mindfulness is associated with increased alpha and theta power in both healthy populations and patient groups, which may signify a relaxed alertness state contributing to mental health. 117

Systematic reviews on RCTs revealed that mindfulness meditation have effects on stress and immune-related physiological markers of inflammation, cell-mediated immunity and biological aging: reductions in the activity of the cellular transcription factor NF-kB, reductions in circulating levels of C-reactive protein, increases in CD4+ T cell count (in HIV-diagnosed individuals), and increases in telomerase activity. 120 Another systematic review on RCTs found that, compared to an active control (relaxation, exercise or education), mindfulness meditation reduced physiological markers of stress, such as cortisol, C-reactive protein, systolic blood pressure, heart rate, triglycerides and tumour necrosis factor-alpha, in various populations. 121 And a greater number of hours of meditation are associated with a greater impact on telomere biology. 122 However, these tentative findings need further replication and the review authors call for studies to include physiological markers as primary outcome of RCTs. 120–123

Ethics of MBIs

Ethical questions are fundamental and essential in guiding the future directions of MBIs to use the right mindfulness rightly, and also the application of MBIs should not overstate the organizational and social determinants of ill health. In the books of ‘Practitioner’s Guide to Ethics and Mindfulness-Based Interventions’ (edited by Lynette Monteiro, Jane Compson and Frank Musten) and ‘Handbook of Ethical Foundations of Mindfulness’ (edited by Stanley Steven, Ronald Purser and Nirbhay Singh), ethical questions of mindfulness are discussed extensively. Many questions on ethics are yet to be addressed for MBIs. For example, paradox in teaching mindfulness in business and military settings, depriving superiors to make use of subordinates through mindfulness regardless of other organizational factors causing work-related stress or depression. On the other hand, there are many virtues and strengths in MBIs in providing personally meaningful and prosocial values, 124 and MBIs can improve ethical standards, that mindfulness promotes greater ethical intentions and lesser ethical infractions, with more mindful people revealed a greater emphasis on moral principles than those who are less mindful. 125

Safety of MBIs

MBIs are regarded as relatively safe interventions. 126 Like many other psychological intervention trials, adverse events and adverse effects of MBIs are largely underreported. A previous systematic review on safety of MBSR and MBCT indicated that fewer than one in five trials had mentioned the monitoring of adverse effects. 126 Program-related factors, participant-related factors, and clinician- or teacher-related factors are potential sources of adverse effects. 1 , 126–132 A safety checklist is yet needed to be built based on previous studies and empirical experiences. Practitioners and researchers in future MBI programmes are advised to report the potential adverse events using such a checklist, and also continue to take safety precautions such as screening and caring for vulnerable individuals. These individuals could be those with PTSD, seizure disorder/epilepsy, acute psychosis, mania, suicidality or other health problems of concern. 133

Future directions

Despite the increasing trend of mindfulness studies and applications, there are still many areas need exploration. First, higher quality of research studies is needed. The most frequent limitations mentioned in the systematic reviews on effectiveness and cost-effectiveness of MBIs are low quality of study design, small sample size, short follow-up period, and inconsistent terminology and measurement tools. Future more robust studies are needed to address these caveats. Second, more studies on online MBIs intervention and training are needed to understand if online alternatives have equal or better effects and cost-effectiveness, though preliminary benefits are seen. 10 , 134 , 135 Online alternatives might be important, especially given the pandemic of COVID-19. Third, more understanding of the mechanisms by integrating both empirical findings and neurophysiological findings. Fourth, more research is needed to explore the acceptance and compliance of MBIs to understand who might benefit more from MBIs, and barriers and respective strategies (e.g. better meditation environment) for improving the acceptance and compliance, taken into considerations of safety issues and ethical concerns. And a closer look at the long-term compliance is needed. This may call for large-scale cohort studies on MBIs. Fifth, develop more mindfulness related research and services guidelines and regulations, e.g. on adverse events monitoring and safety guarantee, and qualifications of mindfulness teachers. These might be important when MBIs are provided as a collective action in schools, companies or organizations. Sixth, exploration of Mindfulness Plus (Mindfulness+), i.e. combination of MBIs with other effective interventions (for example, mindfulness plus medications, mindfulness plus behavioural activation, 136 mindfulness plus reflection training 137 and mindfulness plus Qigong movement therapy 138 ), or exploration of personalized/individualized mindfulness-based interventions for individuals with different characteristics and needs, selecting from many different mindfulness programs. This would provide more potential to improve the effects of MBIs for different goals.

MBIs are effective for many common mental, physical and social health conditions among different populations. Beneficial effects of MBIs have been found on depression, anxiety, stress, insomnia, addiction, psychosis, pain, hypertension, weight control, cancer-related symptoms and prosocial behaviours. Current evidence suggested MBIs can be beneficial for healthcare professionals and within schools and workplaces although more studies are still needed to look into its efficacy on many different biopsychosocial health conditions. MBIs are relatively safe. Ethical aspects should always be taken into account during mindfulness-based trainings and interventions. Mechanisms of MBIs have been suggested in both empirical and neurophysiological findings. Cost-effectiveness is found for some health problems (e.g. breast cancer, fibromyalgia, low back pain or caregiver training). More high-quality studies with adequate sample size and longer follow-up duration are needed to confirm its effectiveness and cost-effectiveness in many other problems and among sub-groups. Some other areas needing additional research are suggested in this review.

Contributor Information

Dexing Zhang, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China.

Eric K P Lee, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China.

Eva C W Mak, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China.

C Y Ho, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China.

Samuel Y S Wong, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China. Thomas Jing Mindfulness Centre for Research and Training, The Chinese University of Hong Kong, Hong Kong SAR, China.

Conflict of interest statement

Data availability statement.

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Research: When Mindfulness Does — and Doesn’t — Help at Work

• Lindsey D. Cameron
• Andrew Hafenbrack

We all need to identify the most effective practices for our unique roles, routines, and minds.

Mindfulness meditation practices can be an effective way to reduce stress and improve well-being in certain contexts. But as more and more employers offer some form of mindfulness training to their employees, it isn’t always clear whether these programs are actually paying off. To explore the impact of mindfulness in the workplace, the authors conducted a series of field studies in real-world work environments — and they found that while mindfulness can in fact be beneficial in some situations, it can be less effective (or even counterproductive) in others. Specifically, they found that both breath-based and loving-kindness meditation can help reduce the stress associated with emotionally charged social interactions, but that breath-focused meditation can actually make people less helpful in situations that require them to take accountability. As such, especially for programs targeting managers or executives (whose roles often necessitate the ability to take responsibility for past mistakes and proactively address issues), the authors suggest that breath-based meditation may not be the best approach. They go on to offer three strategies to help organizations implement the targeted mindfulness programs that will be most beneficial for everyone, ultimately suggesting that it’s critical for us all to identify the mindfulness practices that will be most effective for our unique roles, routines, and minds.

More than half of American employers offer some form of mindfulness training to their workers, contributing to a global corporate wellness market that’s valued at over $50 billion . But are these investments actually paying off?

• LC Lindsey D. Cameron is a management professor at the University of Pennsylvania’s Wharton School, a fellow at the Institute for Advanced Study, and a faculty associate at Harvard University’s Berkman Klein Center for Internet and Society. She studies algorithmic management, digital platforms, and labor issues.
• AH Andrew Hafenbrack is an assistant professor at the University of Washington’s Foster School of Business. His research focuses on the benefits and costs of mindfulness meditation and culture. He has meditated for twelve years and lived in seven countries. You can watch a TED-like presentation on his mindfulness research here or visit his website at www.andyhafenbrack.com .

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A Case Study on the Use of Meditation Techniques to Develop Mindfulness in MBA Supply Chain Management Students

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• Lucy McCarthy 5 ,
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• Jim Pugh 7  

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An increased focus on spirituality and mindfulness in the management education literature has resulted in calls for greater empirical work of a nontraditional nature. Therefore, this research looks to contribute to this growing body of literature by looking at the deployment of a specific aspect of spirituality, mindfulness, in a higher education context in the teaching of a Master of Business Administration (MBA) supply chain management (SCM) module. This research shows that the use of meditation techniques by SCM students can engender mindfulness and increase their attention, awareness, and acceptance. In this case study, students completed a learning journal reflecting their experiences of meditation over a 6-week period. Grounded theory techniques articulated a model of the meditation exercise in this context. The research found a number of expected and unexpected benefits, including students’ ability to focus for longer periods of time. The costs of the exercise, cited only by self-identified skeptical students, included an increase in stress and frustration with the exercise. The subsequent analysis and model show how to improve the techniques and prevent negative outcomes.

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Marshall, D., McCarthy, L., Kelly, S., Pugh, J. (2018). A Case Study on the Use of Meditation Techniques to Develop Mindfulness in MBA Supply Chain Management Students. In: Roberts, G., Crossman, J. (eds) The Palgrave Handbook of Workplace Spirituality and Fulfillment. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-62163-0_42

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Mindful learning: a case study of langerian mindfulness in schools.

• 1 Department of Education, University of California, Berkeley, Berkeley, CA, USA
• 2 Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
• 3 Department of Psychology, Harvard University, Cambridge, MA, USA

The K-12 classroom applications of mindfulness as developed by Ellen Langer are discussed in a case study of a first-year charter school. Langerian Mindfulness, which is the act of drawing distinctions and noticing novelty, is deeply related to well-being and creativity, yet its impact has yet to be tested at the primary or secondary school level. The objective of the article is to display how Langerian Mindfulness strategies could increase 21st century skills and Social-Emotional Learning in primary classrooms. The New School San Francisco, an inquiry-based, socioeconomically and racially integrated charter school, serves as a model for mindful teaching and learning strategies. It is concluded that when mindful strategies are implemented, students have significant opportunities to exercise the 21st century skills of creativity, collaboration, communication and critical thinking. Langerian Mindfulness is also considered as a tool for increasing Social-Emotional Learning in integrated classrooms. It is recommended that mindful interventions be further investigated in the primary and secondary school context.

Introduction

Models of educational change have increasingly prioritized the development of creativity, communication, collaboration and critical thinking in 21st century students ( Bellanca, 2010 ). These 21st century skills, often referred to collectively as the “Four C’s,” are considered by many to be prerequisites for students entering a dynamically shifting working world ( Kaufman and Beghetto, 2009 ). How do proponents of the Four C’s propose that teachers plant these skills in their students? Some models call for the need for technological innovation in schools, arguing that computer-based instruction not only widens students’ professional skill base as the workplace becomes increasingly automated but also frees teachers up to focus on relationship building and the development of the Four C’s ( Bellanca, 2010 ). Other educational change agents tout Project-Based Learning as the key to unlocking 21st century skills ( Bell, 2010 ). Advocates of Project-Based Learning maintain that ongoing engagement in collaborative projects expose children to real-life situations in which to practice the Four C’s. In this paper, we will describe how an alternative approach, Langerian Mindfulness ( Langer, 1989 ), could be instrumental in promoting 21st century skills. While Langerian Mindfulness is complementary to the models of educational change described above, we will attempt to highlight how more than 40 years of mindfulness research can improve the social-emotional and academic growth of both students and teachers.

Mindful learning is a divergent and context-dependent approach to ideas. While convergent, narrow thinking plays a vital role in our ability to organize, prioritize and decide, other thought processes expand, rather than condense our ideas ( Langer, 1993 ). Divergent thinking is a mind-expanding process commonly associated with creativity ( Nusbaum and Silvia, 2011 ). To think divergently is to examine an idea by considering its alternatives, creating more possibilities rather than narrowing our focus to one specific answer. When we learn mindfully, we channel this divergent thinking process by considering multiple perspectives in search of multiple solutions to fit multiple contexts ( Langer, 1989 , 1993 ).

While there are different approaches to mindfulness ( Pagnini and Phillips, 2015 ), we will refer to the concept developed by Langer (1989) , who defines mindfulness as the simple process of noticing new things and drawing novel distinctions. This concept is rooted in the awareness that reality is in constant change. Paying attention of big and subtle changes in reality (either internal or external) forces a person to stay in the present, in the moment. When mindful, people are sensitive to the environment and the context, they create new categories for structuring perception, they welcome novelties, and they present multiple perspectives in problem solving ( Langer and Moldoveanu, 2000 ). This awareness of multiple perspectives helps reducing the need for previously established categories, promoting mind-openness and engagement ( Langer, 1992 ). The opposite of mindfulness, mindlessness, consists in relying on previously established categories. When mindless, one acts as a pre-programmed machine, behaving according to categories created in the past. When that happens, the person is entangled in a single and inflexible perspective, unaware of other possible ways of knowing. Most concepts from social psychology (e.g., stereotypes, prejudices) refer to mindlessness ( Langer and Moldoveanu, 2000 ). According to Langer, mindfulness can be easily taught by inviting people to notice differences and to pay attention to new elements that were not part of the previous schema.

Mindful Education in Practice

While Langerian mindfulness proved to be a powerful tool for education and learning in undergraduates and high-school students ( Langer et al., 1989 ), there is a lack of reports about the application of her theories in elementary classrooms. In this case study of The New School San Francisco, we explore how Mindfulness has been implemented from the perspectives of both teachers and students. Our exploration of one mindful school will be followed by a discussion of how mindful practices could be applied in other teaching and learning contexts. Our references to “mindful learning,” relate to the mindful practices related to noticing new things and drawing novel distinctions, according to the Langerian mindfulness model ( Langer, 1989 ). Meditation-based practices developed by classroom pioneers such as Snel (2013) have demonstrated powerful effects on children’s focus and social-emotional awareness, but Langerian mindfulness does not incorporate meditation, nor do teachers and students at New School San Francisco. Rather than meditating, New School teachers encourage students to actively notice changes in context and consider situations from multiple perspectives. We will provide explicit examples of these mindful learning techniques throughout this case study.

The New School San Francisco (NSSF) opened its doors in the fall of 2015 as an inquiry-based charter school committed to Social-Emotional Learning. At NSSF, “Inquiry” is a pedagogical process that is “driven by student voice and choice” and that “strongly supports educators to implement student ideas, questions and solutions into the learning progression” ( New School San Francisco, 2015 ) Teachers and administrators at NSSF are encouraged to be responsive to the interests and needs of their students. Many schools have implemented inquiry-based approaches, but NSSF is unique in that it offers inquiry-based strategies to a socioeconomically integrated population. The diverse student body at the New School San Francisco mirrors the demographics of the city of San Francisco. Teachers blend inquiry strategies with practices in Social-Emotional Learning to ensure that students receive an equitable education.

Celebrating Diverse Perspectives for Social-Emotional Growth

A landmark of a mindful educational process is not only the acceptance, but also the promotion of differences ( Langer et al., 1985 ). Students can increase their social-emotional awareness through immersion in socioeconomically and ethnically diverse communities. Students’ diverse perspectives are not merely tolerated, they are encouraged and celebrated. For example, in the morning class meeting, each student gets a chance to share his or her Weekend News, so that the diverse out-of-school activities take center stage. This is inline with the decades of research suggesting the social-emotional advantages of integrating students from diverse racial and socioeconomic backgrounds ( Siegel-Hawley and Frankenberg, 2012 ). Contrast socioeconomic and ethnic integration with most public and private primary classrooms, in which students are surrounded by classmates who look, speak and act similarly to themselves. Whether a student attends a private school composed of mainly wealthy children or a lower-income public school that attracts primarily lower-income students, the range of perspectives from which (s)he can consider Weekend News may be significantly narrower. Rather than celebrating diverse perspectives, similarity, rather than difference, is more likely to guide thought and action, dulling the children’s capacity to imagine alternatives.

While the students in NSSF explore diverse possibilities, the teachers in this mindful school actively seek alternative perspectives as well. Each classroom is facilitated by two teachers, a Lead Teacher and a Resident Teacher. While the Lead Teachers have an average of 10 years of experience and the average Resident Teacher has spent less than 3 years in the classroom, the relationship in non-hierarchical. The integration of two different approaches to teaching is considered a creative opportunity rather than a compromise. Teachers are given 90 daily minutes to plan and collaborate so that their diverse backgrounds can inform everything from daily lesson plans to classroom behavior plans. For example, the Lead Teachers may recognize that their training in teacher-directed, convergent schooling balances the Resident Teachers’ more divergent, child-directed approach. In planning a lesson on how to add two numbers to make 10, for example, the teachers may discuss the possibility of a direct model by the teacher or a more exploratory, child-centered exploration of groups of 10 materials. Realizing that their two perspectives are compatible, the teachers decide to begin their lesson with a guided exploration of groups of 10, followed by a teacher-led discussion to cement the students’ findings. Research on collaborative teaching has revealed significant benefits for both teachers and students in a variety of schools ( Gillespie and Israetel, 2008 ). At NSSF, the synergy of varied levels of educational experiences and philosophies is what leads to the creative and mindful teaching and learning experience. When confronted with ideas that appear mutually exclusive, mindful teachers recognize and celebrate the possibility of a creative solution that integrates both perspectives.

Celebrating Diverse Solutions

Students in a mindful context exercise their ability to generate a variety of solutions, rather than converging on one correct answer. In NSSF, for example, students play a game called “Magic Number 10,” in which learners are challenged to think of as many ways as possible ways to add two numbers to make 10. Students create not only different combinations of numbers (8 + 2, 7 + 3) but also different contexts in which the numbers can be applied (10 fingers, 10 students, 10 cookies, 10 dollars).

Contrast this divergent approach with the more convergent method of adding two numbers to make 10. Students would be given the formula “8 + 2 = 10” and may be asked to solve for the answer. Students who learn to add using the convergent method would be likely to apply the addition method only when asked to solve for 8 + 2. The mindful students, however, will readily apply the adding strategies whenever they are reminded of cookies, or dollars or a group of 10 students. Consistent with emerging research on instructional width ( Pepkin, 2004 ), when teachers encourage diverse student ideas into the generation of solutions, students are more likely to use mathematical methods than when the discussion is more narrowly focused on solutions provided by the teacher.

From a teacher’s perspective, the mindful search for alternative solutions could be applied to troubleshooting socially unacceptable classroom behavior. When there is a behavior issue, teachers are challenged to think: “How might this make sense from the students’ perspective?” For example, mindful teachers would fully engage with the perspective of a child who consistently becomes violent, kicking and punching the teachers and students around him. Rather than punishing the student for his behavior, the teachers meet with each other, with the student’s parents and with the school administration to discuss their observations of the student and to consider the variety of ways the behavior might make sense from the student’s perspective. What is the purpose of the student’s violence? How could we teach the child an alternative method of reaching his goal? Could the child be using the violence as a way to avoid the academic work that he loathes? Might the child have language deficits that prevent him from expressing his anger with words, so that he overcompensates by punching and kicking? As the caregiving team for the child develop a range of possibilities to explain the student’s outbursts, each option is considered as the teachers collect data on the antecedents and consequences of the student’s behavior. The teachers begin to understand the student’s current developmental capacity for expressing himself, and can then guide the child up along the developmental spectrum of emotional expression. This approach represents an alternative to a more convergent classroom in which a comprehensive system of rewards and punishments governs behavior. In the convergent case, students are given explicit rules to guide behavior such as, “Keep Your Hands to Yourself” and are either punished or rewarded depending on their adherence to the rule. Not only might this strategy undermine the students’ intrinsic desire to follow the rules by rewarding positive behavior with incentives, it also prevents both teachers and learners from understanding the root of the troubling behaviors, and from growing as a result of this understanding. Teachers learn very little about how students would express themselves in a more realistic context in which peaceful expression of frustration is not followed with a sticker or gold star. Students begin to learn how to please teachers, rather than learning the intricacies of prosocial context-dependent behavior. A child in a convergent classroom may act in the “right” way to get a gold star, but may not realize the contexts in which a hug, or even a shove, may be appropriate.

Expression of 21st Century Skills

While students at NSSF are not explicitly tested in their development of creativity, communication, collaboration and critical thinking, their mindful learning process provides them with intentional opportunities to exercise these skills. Mindful New School teachers segment their inquiry-based approach into three stages: Exploration, Expression and Exposition. As classrooms devote 4 weeks to each of these three stages, the 12-week learning period evolves into a comprehensive unit of inquiry. During the 12-week period, teachers guide students through activities that require creativity, communication, collaboration and critical thinking.

In the first stage of this learning process, exploration, teachers develop a list of four possible topics in which the students have demonstrated significant interest. The process of generating multiple topics of exploration is mindful in that the teachers are not only encouraging the students to engage in multiple possible areas of study, but also responsively considering topics highly relevant to the students’ specific learning context ( Langer, 1993 ). Over the course of the 4 weeks, the students and teachers explore each topic through “provocations” designed by the teachers to inspire creativity and curiosity in the students. For example, for an exploration of market economies at NSSF, first-grade teachers prompt students to create a factory using clay, blocks and crafting materials. Teachers celebrate diverse processes and products throughout the creative exploration phase. Students exercise both their creative and communicative skills as they are challenged to articulate the significance of their creations and the processes they used to create them.

In the expression phase, teachers choose one especially engaging topic to explore further as students add to their creative and communicative foundation with more complex elements of critical thinking. Teachers expose students to discrete skills and concepts that will help the children consider how the topic of study applies to them personally. For the expression phase of market economies, for example, students are challenged to consider what goods and services do and do not exist in the community. The students would then decide which of these goods or services that they each want to contribute to the community, and which resources will be necessary to execute their community contribution. This expression process is particularly mindful because it encourages students to consider how their learning applies to their specific context. Students critically weigh their observations of their community with their prior knowledge and passions until they develop concrete and personally meaningful goods or services to contribute to their community.

The culminating exhibition phase touches on all four 21st century skills as students collaboratively create a product of their learning and communicate their critical thinking throughout the learning process. Some New School first-graders may team up to create a bread factory after realizing that the community had many factories producing tortillas but few options for producing or consuming bread. Given the collaborative nature of the project, teachers challenge each student to communicate his or her specific roles in the factory-creation process. By explaining their decision to create a bread factory, students critically examine and justify the factors that led to their decision. While fielding questions from peers, teachers and parents, students mindfully consider alternatives to the final products that they created and alternative processes that they could have used along the way.

The process of exploration, expression and exhibition encourages students to consider the various paths that could be taken to a specific solution and the multiple possible solutions to any one problem. That allows students to maintain and cultivate a mindful perspective, that is open and flexible, rather than narrow it down with a pre-prepared outcome. Students grow their capacities to create, communicate, collaborate and think critically while situating their newfound skills and ideas into a personally meaningful learning context.

Many learning processes utilize a narrowing of perspective at all levels of education ( Langer, 1997 ). A child learning a new language takes diverse stimuli and categorizes experiences into words and phrases. Middle school students clarify their writing by narrowing the scope of their thesis statements. High School students devote countless hours to SAT prep, focusing their attention on finding the right answer for any question. These narrowing thought processes are examples of convergent thinking ( Guilford, 1956 ) which prioritizes speed, accuracy and logic to eliminate possibilities and arrive at a “correct” answer. Teachers in low-income public schools have expressed increased pressure for teachers and learners to converge on a single “correct” answer ( Davenport, 2014 ). Few public schools offer an educational model that prioritizes mindfulness and divergent thinking, which could be more common in private schools.

Alternatively, the application of Langerian mindfulness to pedagogy offers learners ample opportunities to exercise the 21st century skills of creativity, communication, collaboration and critical thinking. Mindful interventions in primary and secondary schools could potentially promote both Social-Emotional Learning and application of mathematical methods. Mindful perspective-taking for students with different socio-cultural backgrounds may promote context-dependent social-emotional awareness. A mindful search for alternative solutions could also promote instructional width, increasing the likelihood that students will apply the mathematical methods being taught. The process of seeking different perspectives celebrates diversity and integration, eventually resulting in improved life satisfaction ( Langer, 1989 ). The classroom application of Langerian Mindfulness is a compelling and potentially paradigm-shifting area of future educational research.

Author Contributions

FP provided the context for the article. As an associate in Dr. Ellen Langer’s research lab, FP explains why mindful education practices are vital for students in the 21st century. CD contributed the sections on mindful education in practice. As a credentialed primary school teacher and researcher in Dr. Ellen Langer’s research lab, CD discusses how Dr. Langer’s theories are implemented in a particular primary school in San Francisco, CA.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Keywords : mindfulness, mindful education, 21st century skills, creativity

Citation: Davenport C and Pagnini F (2016) Mindful Learning: A Case Study of Langerian Mindfulness in Schools. Front. Psychol. 7:1372. doi: 10.3389/fpsyg.2016.01372

Received: 05 July 2016; Accepted: 29 August 2016; Published: 12 September 2016.

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Copyright © 2016 Davenport and Pagnini. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Francesco Pagnini, [email protected]

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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HSBC Case Study

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A case study detailing the mindfulness-based offerings at HSBC and the expansion of the programme from a grass-roots initiative to a successful global programme.