Social:Mindfulness-based stress reduction

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Short description: Program offering mindfulness training
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Mindfulness-based stress reduction (MBSR) is an eight-week evidence-based program that offers secular, intensive mindfulness training to assist people with stress, anxiety, depression and pain.[1][2][3] Developed at the University of Massachusetts Medical Center in the 1970s by Professor Jon Kabat-Zinn, MBSR uses a combination of mindfulness meditation, body awareness, yoga and exploration of patterns of behavior, thinking, feeling and action.[1][4] Mindfulness can be understood as the non-judgmental acceptance and investigation of present experience, including body sensations, internal mental states, thoughts, emotions, impulses and memories, in order to reduce suffering or distress and to increase well-being.[1][5] Mindfulness meditation is a method by which attention skills are cultivated, emotional regulation is developed, and rumination and worry are significantly reduced.[5][6][1] During the past decades, mindfulness meditation has been the subject of more controlled clinical research, which suggests its potential beneficial effects for mental health,[7][8][9] as well as physical health.[10][11][12] While MBSR has its roots in wisdom teachings of Zen Buddhism, Hatha Yoga, Vipassana and Advaita Vedanta, the program itself is secular.[1][13] The MBSR program is described in detail in Kabat-Zinn's 1990 book Full Catastrophe Living.[1]

History

Jon Kabat-Zinn, founder of the Mindfulness Based Stress Reduction Clinic

In 1979, Jon Kabat-Zinn founded the Mindfulness Based Stress Reduction Clinic at the University of Massachusetts Medical Center, and nearly twenty years later the Center for Mindfulness in Medicine, Health Care and Society at the University of Massachusetts Medical School.[4] Both these institutions supported the growth and implementation of MBSR into hospitals worldwide.[1] Kabat-Zinn described the MBSR program in detail in his bestselling 1990 book Full Catastrophe Living, which was reissued in a revised edition in 2013.[1] In 1993, the MBSR course taught by Jon Kabat-Zinn was featured in Bill Moyer's Healing from Within.[14] In the year 2015, close to 80% of medical schools are reported[15] to offer some element of mindfulness training, and research and education centers dedicated to mindfulness have proliferated.

Program

A meta-analysis described MBSR as "a group program that focuses upon the progressive acquisition of mindful awareness, of mindfulness".[16] The MBSR program is an eight-week workshop taught by certified trainers that entails weekly group meetings (2.5 hour classes) and a one-day retreat (seven-hour mindfulness practice) between sessions six and seven, homework (45 minutes daily), and instruction in three formal techniques: mindfulness meditation, body scanning and simple yoga postures.[1] Group discussions and exploration - of experience of the meditation practice and its application to life - is a central part of the program. Body scanning is the first prolonged formal mindfulness technique taught during the first four weeks of the course, and entails quietly sitting or lying and systematically focusing one's attention on various regions of the body, starting with the toes and moving up slowly to the top of the head.[1][4] MBSR is based on non-judging, non-striving, acceptance, letting go, beginners mind, patience, trust, and non-centering.[17][1]

According to Kabat-Zinn, the basis of MBSR is mindfulness, which he defined as "moment-to-moment, non-judgmental awareness."[1] During the program, participants are asked to focus on informal practice as well by incorporating mindfulness into their daily routines.[1] Focusing on the present is thought to heighten sensitivity to the environment and one's own reactions to it, consequently enhancing self-management and coping. It also provides an outlet from ruminating on the past or worrying about the future, breaking the cycle of these maladaptive cognitive processes.[18] The validity and reliability of a weekly single-item practice quality assessment have been confirmed by research. Increases in practice quality predicted improvements in self-report mindfulness and psychological symptoms but not behavioral mindfulness, and longer practice sessions were linked to better practice quality.[19]

Scientific evidence of the debilitating effects of stress on human body and its evolutionary origins were pinpointed by the work[20] of Robert Sapolsky, and explored for lay readers in the book Why Zebras Don't Get Ulcers.[21] Engaging in mindfulness meditation brings about significant reductions in psychological stress,[7][22][23] and appears to prevent the associated physiological changes and biological clinical manifestations that happen as a result of psychological stress.[11][12][10] According to early neuroimaging studies, MBSR training has an influence on the areas of the brain responsible for attention, introspection, and emotional processing.[24]

Extent of practice

According to a 2014 article in Time magazine, mindfulness meditation is becoming popular among people who would not normally consider meditation.[25] The curriculum started by Kabat-Zinn at University of Massachusetts Medical Center has produced nearly 1,000 certified MBSR instructors who are in nearly every state in the US and more than 30 countries. Corporations such as General Mills have made MBSR instruction available to their employees or set aside rooms for meditation. Democratic Congressman Tim Ryan published a book in 2012 titled A Mindful Nation and he has helped organize regular group meditation periods on Capitol Hill.[25][26]

Methods of practice

Mindfulness-based stress reduction classes and programs are offered by various facilities including hospitals, retreat centers, and various yoga facilities.[27] Typically the programs focus on teaching:

  • Mind and body awareness to reduce the physiological effects of stress, pain or illness
  • Experiential exploration of experiences of stress and distress to develop less emotional reactivity
  • Equanimity in the face of change and loss that is natural to any human life
  • Non-judgmental awareness in daily life
  • Promote serenity and clarity in each moment
  • To experience more joyful life and access inner resources for healing and stress management
  • Mindfulness meditation

Evaluation of effectiveness

Mindfulness-based approaches have been found to be beneficial for healthy adults[7][28][29] for adolescents and children,[30][31] healthcare professionals,[32] as well as for different health-related outcomes including eating disorders,[33][34][35] psychiatric conditions,[36][37][38][39] pain management [40][5][41] sleep disorders,[42][43] cancer care,[44][45] psychological distress, and for coping with health-related conditions.[46][47][48][49] As a major subject of increasing research interest, 52 papers were published in 2003, rising to 477 by 2012.[25] Nearly 100 randomized controlled trials had been published by early 2014.[50]

The development of therapies to improve individuals' flexibility in switching between using and not using emotion regulation (ER) methods is necessary because it is linked to better mental health, wellbeing, and resilience. According to research, those who attended MBSR training exhibited greater regulatory decision flexibility.[51] In post-secondary students, research on mindfulness-based stress reduction has demonstrated that it can reduce psychological distress, which is common in this age range. In one study, the long-term impact of an 8-week Mindfulness-Based Stress Reduction (MBSR) treatment extended to two months after the intervention was completed.[52]

Research suggests mindfulness training improves focus, attention, and ability to work under stress.[53][54][55] Mindfulness may also have potential benefits for cardiovascular health.[56][57][58] Evidence suggests efficacy of mindfulness meditation in the treatment of substance use disorders.[59][60][61] Mindfulness training may also be beneficial for people with fibromyalgia.[62][63][64]

In addition, recent research has explored the ability of mindfulness-based stress reduction to increase self-compassion and enhance the well-being of those who are caregivers, specifically mothers, for youth struggling with substance use disorders.[65] Mindfulness-based interventions allowed for the mothers to experience a decrease in stress as well as a better relationship with themselves which resulted in improved interpersonal relationships.

It has been demonstrated that mindfulness-based stress reduction has beneficial impacts on healthy individuals as well as suffering individuals and those close to suffering individuals. Roca et al. (2019) conducted an 8-week mindfulness-based stress reduction program for healthy participants.[66] Five pillars of MBSR, including mindfulness, compassion, psychological well-being, psychological distress, and emotional-cognitive control were identified. Participants psychological functioning were examined and assessed using questionnaires. Mindfulness and overall well-being was significant between the five pillars observed.

Mindfulness-based interventions and their impact have become prevalent in every-day life, especially when rooted in an academic setting. After interviewing children, of the average age of 11, it was apparent that mindfulness had contributed to their ability to regulate their emotions.[67] In addition to these findings, these children expressed that the more mindfulness was incorporated by their school and teachers, the easier it was to apply its principles. In a 2021 Cochrane review for mindfulness-based psychological interventions for medical students and junior doctors its utility remained unconfirmed due to few studies and risk of bias.[68]

MBIs (mindfulness-based interventions) showed a positive effect on mental and somatic health in social when compared to other active treatments in adults. These effects are largely independent of gender, study sample, duration and compliance with the MBSR intervention.[69]

See also

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Bantam Dell. 2013. ISBN 978-0345539724. 
  2. ↑ "Mindfulness meditation: A research-proven way to reduce stress". October 30, 2019. https://www.apa.org/topics/mindfulness-meditation. 
  3. ↑ "Neural Basis of Mindfulness Interventions that Moderate the Impact of Stress on the Brain". Neuropsychopharmacology 41 (1): 373. January 2016. doi:10.1038/npp.2015.239. PMID 26657952. 
  4. ↑ 4.0 4.1 4.2 Kabat-Zinn J. (2003). "Mindfulness-based interventions in context: past, present, and future". Clinical Psychology: Science and Practice 10 (2): 144–156. doi:10.1093/clipsy.bpg016. 
  5. ↑ 5.0 5.1 5.2 "Mindfulness Interventions". Annual Review of Psychology 68: 491–516. January 2017. doi:10.1146/annurev-psych-042716-051139. PMID 27687118. 
  6. ↑ "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". Clinical Psychology Review 37: 1–12. April 2015. doi:10.1016/j.cpr.2015.01.006. PMID 25689576. 
  7. ↑ 7.0 7.1 7.2 "Mindfulness-based stress reduction for healthy individuals: A meta-analysis". Journal of Psychosomatic Research 78 (6): 519–528. June 2015. doi:10.1016/j.jpsychores.2015.03.009. PMID 25818837. 
  8. ↑ "Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis". Clinical Psychology Review 59: 52–60. February 2018. doi:10.1016/j.cpr.2017.10.011. PMID 29126747. 
  9. ↑ "Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence". Journal of Psychiatry & Neuroscience 43 (1): 7–25. January 2018. doi:10.1503/jpn.170021. PMID 29252162. 
  10. ↑ 10.0 10.1 "Mindfulness meditation and the immune system: a systematic review of randomized controlled trials". Annals of the New York Academy of Sciences 1373 (1): 13–24. June 2016. doi:10.1111/nyas.12998. PMID 26799456. Bibcode: 2016NYASA1373...13B. 
  11. ↑ 11.0 11.1 "Pathways to well-being: Untangling the causal relationships among biopsychosocial variables". Social Science & Medicine 272: 112846. March 2021. doi:10.1016/j.socscimed.2020.112846. PMID 32089388. https://osf.io/dfu59/. 
  12. ↑ 12.0 12.1 "Mindfulness Training and Physical Health: Mechanisms and Outcomes". Psychosomatic Medicine 81 (3): 224–232. April 2019. doi:10.1097/PSY.0000000000000675. PMID 30806634. 
  13. ↑ "The Mindfulness-Based Wellbeing Enhancement (MBWE) Curriculum". Introducing Mindfulness-Based Wellbeing Enhancement. London: Routledge. 2023-02-20. pp. 240–247. doi:10.4324/9781003322955-4. ISBN 978-1-003-32295-5. http://dx.doi.org/10.4324/9781003322955-4. Retrieved 2023-05-17. 
  14. ↑ "Healing From Within" (in en-US). https://billmoyers.com/content/healing-from-within/. 
  15. ↑ "Exploring the Promise of Mindfulness as Medicine". JAMA 314 (13): 1327–1329. October 2015. doi:10.1001/jama.2015.7023. PMID 26441167. 
  16. ↑ "Mindfulness-based stress reduction and health benefits. A meta-analysis". Journal of Psychosomatic Research 57 (1): 35–43. July 2004. doi:10.1111/j.2042-7166.2003.tb04008.x. PMID 15256293. 
  17. ↑ Frewen, P. A.; Evans, E.M.; Maraj, N.; Dozois, D. J.; Partridge, K. (2008). "Letting go: Mindfulness and negative automatic thinking". Cognitive Therapy and Research 32 (6): 758–774. doi:10.1007/s10608-007-9142-1. https://ir.lib.uwo.ca/context/psychologypub/article/1237/viewcontent/s10608_007_9142_1.pdf. 
  18. ↑ "Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies". Annual Review of Clinical Psychology 7 (1): 141–168. 2011-01-01. doi:10.1146/annurev-clinpsy-032210-104449. PMID 21219193. 
  19. ↑ "Does practice quality mediate the relationship between practice time and outcome in mindfulness-based stress reduction?". Journal of Counseling Psychology 67 (1): 115–122. January 2020. doi:10.31231/osf.io/85qgd. PMID 31343215. 
  20. ↑ "The endocrine stress-response and social status in the wild baboon". Hormones and Behavior 16 (3): 279–292. September 1982. doi:10.1016/0018-506X(82)90027-7. PMID 6890939. 
  21. ↑ Why Zebras Don't Get Ulcers. USA: Holt paperbacks. 2004. pp. 560. ISBN 978-0805073690. 
  22. ↑ "Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review". Journal of Evidence-Based Complementary & Alternative Medicine 19 (4): 271–286. October 2014. doi:10.1177/2156587214543143. PMID 25053754. 
  23. ↑ "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review". Journal of Consulting and Clinical Psychology 78 (2): 169–183. April 2010. doi:10.1037/a0018555. PMID 20350028. 
  24. ↑ "Neural changes associated with mindfulness-based stress reduction (MBSR): Current knowledge, limitations, and future directions.". Psychology & Neuroscience 10 (1): 41–56. March 2017. doi:10.1037/pne0000073. 
  25. ↑ 25.0 25.1 25.2 Pickert, K. (February 2014). "The art of being mindful. Finding peace in a stressed-out, digitally dependent culture may just be a matter of thinking differently". Time 183 (4): 40–6. PMID 24640415. http://content.time.com/time/subscriber/article/0,33009,2163560,00.html. 
  26. ↑ "A Meditation on the Quiet Time Caucus". Roll Call. January 8, 2014. http://hoh.rollcall.com/a-meditation-on-the-quiet-time-caucus/. 
  27. ↑ "Mindfulness based stress reduction at El Camino Hospital, Mountain View, CA". 2015. https://www.elcaminohospital.org/stay-healthy/class/mindfulness-based-stress-reduction-program-free-introductory-session. 
  28. ↑ "Mindfulness-Based Programs in the Workplace: a Meta-Analysis of Randomized Controlled Trials". Mindfulness 11 (7): 1579–1598. 2 March 2020. doi:10.1007/s12671-020-01328-3. 
  29. ↑ "Mindfulness-Based Interventions for University Students: A Systematic Review and Meta-Analysis of Randomised Controlled Trials". Applied Psychology. Health and Well-Being 12 (2): 384–410. July 2020. doi:10.1111/aphw.12188. PMID 31743957. 
  30. ↑ "Mindfulness-based interventions in schools-a systematic review and meta-analysis". Frontiers in Psychology 5: 603. 2014. doi:10.3389/fpsyg.2014.00603. PMID 25071620. 
  31. ↑ "Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents - a meta-analysis of randomized controlled trials". Journal of Child Psychology and Psychiatry, and Allied Disciplines 60 (3): 244–258. March 2019. doi:10.1111/jcpp.12980. PMID 30345511. 
  32. ↑ "The Effectiveness of Mindfulness-Based Stress Reduction on the Psychological Functioning of Healthcare Professionals: a Systematic Review". Mindfulness 12 (1): 1–28. 2020-09-24. doi:10.1007/s12671-020-01500-9. PMID 32989406. 
  33. ↑ "Mindfulness and eating disorder psychopathology: A meta-analysis". The International Journal of Eating Disorders 53 (6): 834–851. June 2020. doi:10.1002/eat.23247. PMID 32100320. 
  34. ↑ "Mindfulness-based interventions for weight loss: a systematic review and meta-analysis". Obesity Reviews 19 (2): 164–177. February 2018. doi:10.1111/obr.12623. PMID 29076610. 
  35. ↑ "Mindfulness-based interventions for adults who are overweight or obese: a meta-analysis of physical and psychological health outcomes". Obesity Reviews 18 (1): 51–67. January 2017. doi:10.1111/obr.12461. PMID 27862826. 
  36. ↑ "A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms". Medicine 98 (23): e15957. June 2019. doi:10.1097/MD.0000000000015957. PMID 31169722. 
  37. ↑ "The Clinical Efficacy of Mindfulness-Based Treatments for Alcohol and Drugs Use Disorders: A Meta-Analytic Review of Randomized and Nonrandomized Controlled Trials". European Addiction Research 24 (3): 137–162. 2018. doi:10.1159/000490762. PMID 30016796. 
  38. ↑ "Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials". Clinical Psychology Review 45: 102–114. April 2016. doi:10.1016/j.cpr.2016.03.009. PMID 27111302. 
  39. ↑ "The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review". Journal of Consulting and Clinical Psychology 78 (2): 169–183. April 2010. doi:10.1037/a0018555. PMID 20350028. 
  40. ↑ "Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis". Annals of Behavioral Medicine 51 (2): 199–213. April 2017. doi:10.1007/s12160-016-9844-2. PMID 27658913. 
  41. ↑ "Brain mechanisms supporting the modulation of pain by mindfulness meditation". The Journal of Neuroscience 31 (14): 5540–5548. April 2011. doi:10.1523/JNEUROSCI.5791-10.2011. PMID 21471390. 
  42. ↑ "Mindfulness-Based Interventions for Insomnia: A Meta-Analysis of Randomized Controlled Trials". Behavioral Sleep Medicine 18 (1): 1–9. 2020. doi:10.1080/15402002.2018.1518228. PMID 30380915. 
  43. ↑ "The Effects of Mindfulness-Based Interventions on Sleep Disturbance: A Meta-Analysis". Adolescent Psychiatry 5 (2): 105–115. 30 April 2015. doi:10.2174/2210676605666150311222928. 
  44. ↑ "The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis". Supportive Care in Cancer 28 (4): 1563–1578. April 2020. doi:10.1007/s00520-019-05219-9. PMID 31834518. 
  45. ↑ "Mindfulness-based stress reduction can alleviate cancer- related fatigue: A meta-analysis". Journal of Psychosomatic Research 130: 109916. March 2020. doi:10.1016/j.jpsychores.2019.109916. PMID 31927347. 
  46. ↑ "Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis". Current Rheumatology Reports 20 (12): 75. October 2018. doi:10.1007/s11926-018-0787-4. PMID 30338418. 
  47. ↑ "Effects of Mindfulness-based interventions on physical symptoms in people with multiple sclerosis - a systematic review and meta-analysis". Multiple Sclerosis and Related Disorders 38: 101493. February 2020. doi:10.1016/j.msard.2019.101493. PMID 31835209. https://eprints.gla.ac.uk/202343/7/202343.pdf. 
  48. ↑ "Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis". BMJ Open Diabetes Research & Care 7 (1): e000757. 11 December 2019. doi:10.1136/bmjdrc-2019-000757. PMID 31908794. 
  49. ↑ "The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review". Annals of Family Medicine 13 (6): 573–582. November 2015. doi:10.1370/afm.1863. PMID 26553897. 
  50. ↑ "Breathing In vs. Spacing Out". New York Times Magazine. January 14, 2014. https://www.nytimes.com/2014/01/19/magazine/breathing-in-vs-spacing-out.html. 
  51. ↑ "An eight-week mindfulness-based stress reduction (MBSR) workshop increases regulatory choice flexibility". Emotion 19 (4): 593–604. June 2019. doi:10.1037/emo0000461. PMID 29952613. 
  52. ↑ "Mindfulness-Based Stress Reduction Reduces Psychological Distress in College Students" (in en). College Student Journal 52 (3): 291–298. 2018. ISSN 0146-3934. https://eric.ed.gov/?id=EJ1191144. 
  53. ↑ "Meditation experience is associated with increased cortical thickness". NeuroReport 16 (17): 1893–1897. November 2005. doi:10.1097/01.wnr.0000186598.66243.19. PMID 16272874. 
  54. ↑ "Losing Focus? Studies Say Meditation May Help". Time. 2010-08-06. http://content.time.com/time/health/article/0,8599,2008914,00.html. 
  55. ↑ "Mindfulness training modifies subsystems of attention". Cognitive, Affective & Behavioral Neuroscience 7 (2): 109–119. June 2007. doi:10.3758/CABN.7.2.109. PMID 17672382. 
  56. ↑ "Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association". Journal of the American Heart Association 6 (10). September 2017. doi:10.1161/JAHA.117.002218. PMID 28963100. 
  57. ↑ "The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models". Psychological Medicine 46 (12): 2467–2484. September 2016. doi:10.1017/S0033291716001392. PMID 27352637. 
  58. ↑ "Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis". Journal of Psychiatric Research 95: 156–178. December 2017. doi:10.1016/j.jpsychires.2017.08.004. PMID 28863392. 
  59. ↑ "Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review". Frontiers in Psychiatry 9 (95): 95. 2018. doi:10.3389/fpsyt.2018.00095. PMID 29651257. 
  60. ↑ "Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence". Substance Use & Misuse 49 (5): 492–512. April 2014. doi:10.3109/10826084.2013.770027. PMID 23461667. 
  61. ↑ "Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface". Frontiers in Psychiatry 4: 173. January 2014. doi:10.3389/fpsyt.2013.00173. PMID 24454293. 
  62. ↑ "Mindfulness Meditation for Fibromyalgia: Mechanistic and Clinical Considerations". Current Rheumatology Reports 19 (9): 59. September 2017. doi:10.1007/s11926-017-0686-0. PMID 28752493. 
  63. ↑ "The effectiveness of mindfulness-based programs on physical symptoms and psychological distress in patients with fibromyalgia: A systematic review". International Journal of Wellbeing 4 (1): 28–45. 5 June 2014. doi:10.5502/ijw.v4i1.2. 
  64. ↑ "A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome". Journal of Psychosomatic Research 75 (6): 500–510. December 2013. doi:10.1016/j.jpsychores.2013.10.010. PMID 24290038. 
  65. ↑ "A pilot of a mindfulness based stress reduction intervention for female caregivers of youth who are experiencing substance use disorders". Addictive Behaviors 103: 106223. April 2020. doi:10.1016/j.addbeh.2019.106223. PMID 31838440. 
  66. ↑ "Does mindfulness change the mind? A novel psychonectome perspective based on Network Analysis". PLOS ONE 14 (7): e0219793. 2019-07-18. doi:10.1371/journal.pone.0219793. PMID 31318929. Bibcode: 2019PLoSO..1419793R. 
  67. ↑ "Exploring experiences of children in applying a school-based mindfulness programme to their lives" (in en). Journal of Child and Family Studies 27 (12): 3935–3951. December 2018. doi:10.1007/s10826-018-1221-2. ISSN 1062-1024. http://eprints.whiterose.ac.uk/135679/1/Hutchinson_Huws_Dorjee_18_Experiences_of_children_applying_mindfulness.docx. 
  68. ↑ "Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors". The Cochrane Database of Systematic Reviews 2021 (12): CD013740. December 2021. doi:10.1002/14651858.CD013740.pub2. PMID 34890044. 
  69. ↑ "Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis" (in en). Campbell Systematic Reviews 13 (1): 1–264. January 2017. doi:10.4073/csr.2017.11. ISSN 1891-1803. 

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