title: Meditation programs for psychological stress and well-being: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation.
  
  
  OBJECTIVE
  To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health-related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations.
  
  
  METHODS
  We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals.
  
  
  RESULTS
  After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health-related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies).
  
  
  CONCLUSIONS
  Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Madhav
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sonal
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Erica M S
authors.initials: EM
authors.lastname: Sibinga
authors.affiliation: Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Neda F
authors.initials: NF
authors.lastname: Gould
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Rowland-Seymour
authors.affiliation: Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Ritu
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Zackary
authors.initials: Z
authors.lastname: Berger
authors.affiliation: Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dana
authors.initials: D
authors.lastname: Sleicher
authors.affiliation: Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: David D
authors.initials: DD
authors.lastname: Maron
authors.affiliation: Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Hasan M
authors.initials: HM
authors.lastname: Shihab
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Padmini D
authors.initials: PD
authors.lastname: Ranasinghe
authors.affiliation: Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Shauna
authors.initials: S
authors.lastname: Linn
authors.affiliation: Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Shonali
authors.initials: S
authors.lastname: Saha
authors.affiliation: Department of Medicine, The Johns Hopkins University, Baltimore, Maryland4Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
authors.affiliation: Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
mesh_terms: D000328:Adult; D000339:Affect; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D003863:Depression / Q000523:psychology / Q000628:therapy; D006801:Humans; D019122:Meditation / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*