Abstract
Purpose
This systematic review aims to summarize eHealth studies with mindfulness- and relaxation-based interventions for medical conditions and to determine whether eHealth interventions have positive effects on health.
Method
A comprehensive search of five databases was conducted for all available studies from 1990 to 2015. Studies were included if the intervention was mainly technology delivered and included a mindfulness- or relaxation-based intervention strategy and if patients with a medical condition were treated. Treatment effects were summarized for different outcomes.
Results
A total of 2383 records were identified, of which 17 studies with 1855 patients were included in this systematic review. These studies were conducted in patients with irritable bowel syndrome, chronic fatigue syndrome, cancer, chronic pain, surgery, and hypertension. All but one study were delivered online through a web-based platform; one study delivered the intervention with iPods. The studies indicate that mindfulness- and relaxation-based eHealth interventions can have positive effects on patients’ general health and psychological well-being. No effects were found for stress or mindfulness. Only five studies reported economic analyses of eHealth interventions without any clear conclusion.
Conclusion
There is some evidence that mindfulness- and relaxation-based eHealth interventions for medical conditions can have positive effects on health outcomes. Therefore, such interventions might be a useful addition to standard medical care. No app studies were retrieved, even though a vast number of smartphone apps exist which aim at increasing users’ health. Therefore, more studies investigating those health apps are needed.
This is a preview of subscription content, access via your institution.

Similar content being viewed by others
References
World Health Organization. http://www.who.int/topics/ehealth/en/. Accessed December 15, 2016.
Elbert NJ, van Os-Medendorp H, van Renselaar W, Ekeland AG, Hakkaart-van Roijen L, Raat H, et al. Effectiveness and cost-effectiveness of ehealth interventions in somatic diseases: a systematic review of systematic reviews and meta-analyses. J Med Internet Res. 2014;16(4):e110. doi:10.2196/jmir.2790.
Meier CA, Fitzgerald MC, Smith JM. eHealth: extending, enhancing, and evolving health care. Annu Rev Biomed Eng. 2013;15:359–82. doi:10.1146/annurev-bioeng-071812-152350.
Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res. 2013;15(2):e37. doi:10.2196/jmir.2281.
Kamel Boulos MN, Wheeler S. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and health care education1. Health Inf Libr J. 2007;24(1):2–23.
Oh H, Rizo C, Enkin M, Jadad A. What is eHealth (3): a systematic review of published definitions. J Med Internet Res. 2005;7(1):e1. doi:10.2196/jmir.7.1.e1.
Fjorback LO, Arendt M, Ornbol E, Fink P, Walach H. Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials. Acta Psychiatr Scand. 2011;124(2):102–19. doi:10.1111/j.1600-0447.2011.01704.x.
Rainforth MV, Schneider RH, Nidich SI, Gaylord-King C, Salerno JW, Anderson JW. Stress reduction programs in patients with elevated blood pressure: a systematic review and meta-analysis. Curr Hypertens Rep. 2007;9(6):520. doi:10.1007/s11906-007-0094-3.
Luebbert K, Dahme B, Hasenbring M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology. 2001;10(6):490–502. doi:10.1002/pon.537.
Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: a meta-analysis. J Psychosom Res. 2004;57(1):35–43. doi:10.1016/S0022-3999(03)00573-7.
Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol (New York). 2003;10:144–56. doi:10.1093/clipsy.bpg016.
Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. J Clin Psychol. 2006;62(3):373–86. doi:10.1002/jclp.20237.
Bishop SR, Lau M, Shapiro S, Carlson L, Anderson ND, Carmody J et al. Mindfulness: a proposed operational definition. Clin Psychol-Sci Pr. 2004;11:230–41. doi:10.1093/clipsy.bph077.
Jacobson E. Progressive relaxation. 2nd ed. Oxford: University of Chicago Press; 1938.
Jain S, Shapiro SL, Swanick S, Roesch SC, Mills PJ, Bell I et al. A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med. 2007;33:11–21. doi:10.1207/s15324796abm3301_2.
Esch T, Fricchione GL, Stefano GB. The therapeutic use of the relaxation response in stress-related diseases. Med Sci Monit. 2003;9(2):RA23–34.
Hoffman JW, Benson H, Arns PA, Stainbrook GL, Landsberg G, Young JB, et al. Reduced sympathetic nervous system responsivity associated with the relaxation response. Science. 1982;215(4529):190–2.
Lazar SW, Bush G, Gollub RL, Fricchione GL, Khalsa G, Benson H. Functional brain mapping of the relaxation response and meditation. Neuroreport. 2000;11(7):1581–5.
Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68(6):539–44. doi:10.1016/j.jpsychores.2009.10.005.
Volpato E, Banfi P, Rogers SM, Pagnini F. Relaxation techniques for people with chronic obstructive pulmonary disease: a systematic review and a meta-analysis. Evid Based Complement Alternat Med. 2015; 2015. doi:10.1155/2015/628365.
Courtois I, Cools F, Calsius J. Effectiveness of body awareness interventions in fibromyalgia and chronic fatigue syndrome: a systematic review and meta-analysis. J Bodyw Mov Ther. 2015;19(1):35–56. doi:10.1016/j.jbmt.2014.04.003.
Feldman G, Greeson J, Senville J. Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behav Res Ther. 2010;48(10):1002–11. doi:10.1016/j.brat.2010.06.006.
Cavanagh K, Strauss C, Forder L, Jones F. Can mindfulness and acceptance be learnt by self-help?: a systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clin Psychol Rev. 2014;34(2):118–29. doi:10.1016/j.cpr.2014.01.001.
Beatty L, Lambert S. A systematic review of internet-based self-help therapeutic interventions to improve distress and disease-control among adults with chronic health conditions. Clin Psychol Rev. 2013;33(4):609–22. doi:10.1016/j.cpr.2013.03.004.
Greenhalgh J, Dickson R, Dundar Y. Biofeedback for hypertension: a systematic review. J Hypertens. 2010;28(4):644–52. doi:10.1097/HJH.0b013e3283370e20.
Kreps GL, Neuhauser L. New directions in eHealth communication: opportunities and challenges. Patient Educ Couns. 2010;78(3):329–36. doi:10.1016/j.pec.2010.01.013.
Fish J, Brimson J, Lynch S. Mindfulness interventions delivered by technology without facilitator involvement: what research exists and what are the clinical outcomes? Mindfulness (N Y). 2016;7(5):1011–23. doi:10.1007/s12671-016-0548-2.
Spijkerman MP, Pots WT, Bohlmeijer ET. Effectiveness of online mindfulness-based interventions in improving mental health: a review and meta-analysis of randomised controlled trials. Clin Psychol Rev. 2016;45:102–14. doi:10.1016/j.cpr.2016.03.009.
Roy-Byrne PP, Davidson KW, Kessler RC, Asmundson GJ, Goodwin RD, Kubzansky L, et al. Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry. 2008;30(3):208–25. doi:10.1016/j.genhosppsych.2007.12.006.
Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147–55. doi:10.1016/j.genhosppsych.2006.11.005.
Sprangers MA, de Regt EB, Andries F, van Agt HM, Bijl RV, de Boer JB, et al. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol. 2000;53(9):895–907.
de Ridder D, Geenen R, Kuijer R, van Middendorp H. Psychological adjustment to chronic disease. Lancet. 2008;372(9634):246–55. doi:10.1016/s0140-6736(08)61078-8.
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley; 2008.
Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84. doi:10.1136/jech.52.6.377.
Andersson E, Ljótsson B, Smit F, Paxling B, Hedman E, Lindefors N, et al. Cost-effectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: results from a randomized controlled trial. BMC Public Health. 2011;11(1):215. doi:10.1186/1471-2458-11-215.
Arroll MA, Attree EA, Marshall CL, Dancey CP. Pilot study investigating the utility of a specialized online symptom management program for individuals with myalgic encephalomyelitis/chronic fatigue syndrome as compared to an online meditation program. Psychol Res Behav Manag. 2014;7:213–21. doi:10.2147/PRBM.S63193.
Beatty L, Koczwara B, Wade T. Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancer-distress: a randomised controlled trial. Support Care Cancer. 2015;24(3):1043–51. doi:10.1007/s00520-015-2867-6.
Berman RL, Iris MA, Bode R, Drengenberg C. The effectiveness of an online mind-body intervention for older adults with chronic pain. J Pain. 2009;10(1):68–79. doi:10.1016/j.jpain.2008.07.006.
Carpenter KM, Stoner SA, Schmitz K, McGregor BA, Doorenbos AZ. An online stress management workbook for breast cancer. J Behav Med. 2014;37(3):458–68. doi:10.1007/s10865-012-9481-6.
Davis MC, Zautra AJ. An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: results of a randomized controlled trial. Ann Behav Med. 2013;46(3):273–84. doi:10.1007/s12160-013-9513-7.
Devineni T, Blanchard EB. A randomized controlled trial of an internet-based treatment for chronic headache. Behav Res Ther. 2005;43(3):277–92. doi:10.1016/j.brat.2004.01.008.
Dowd H, Hogan MJ, McGuire BE, Davis MC, Sarma KM, Fish RA, et al. Comparison of an online mindfulness-based cognitive therapy intervention with online pain management psychoeducation: a randomized controlled study. Clin J Pain. 2015;31(6):517–27. doi:10.1097/AJP.0000000000000201.
Hansen MM. A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients' reports of anxiety, pain, and self-efficacy in healing. BMC Complement Altern Med. 2015;15:92. doi:10.1186/s12906-015-0613-8.
Kleiboer A, Sorbi M, van Silfhout M, Kooistra L, Passchier J. Short-term effectiveness of an online behavioral training in migraine self-management: a randomized controlled trial. Behav Res Ther. 2014;61:61–9. doi:10.1016/j.brat.2014.07.009.
Ljótsson B, Andersson G, Andersson E, Hedman E, Lindfors P, Andréewitch S, et al. Acceptability, effectiveness, and cost-effectiveness of internet-based exposure treatment for irritable bowel syndrome in a clinical sample: a randomized controlled trial. BMC Gastroenterol. 2011;11(1):1. doi:10.1186/1471-230X-11-110.
Ljotsson B, Atterlof E, Lagerlof M, Andersson E, Jernelov S, Hedman E, et al. Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study. Cogn Behav Ther. 2014;43(2):93–104. doi:10.1080/16506073.2013.846401.
Ljotsson B, Falk L, Vesterlund AW, Hedman E, Lindfors P, Ruck C, et al. Internet-delivered exposure and mindfulness based therapy for irritable bowel syndrome-a randomized controlled trial. Behav Res Ther. 2010;48(6):531–9. doi:10.1016/j.brat.2010.03.003.
Ljotsson B, Hedman E, Andersson E, Hesser H, Lindfors P, Hursti T, et al. Internet-delivered exposure-based treatment vs. stress management for irritable bowel syndrome: a randomized trial. Am J Gastroenterol. 2011;106(8):1481–91. doi:10.1038/ajg.2011.139.
Ljotsson B, Hesser H, Andersson E, Lackner JM, El Alaoui S, Falk L, et al. Provoking symptoms to relieve symptoms: a randomized controlled dismantling study of exposure therapy in irritable bowel syndrome. Behav Res Ther. 2014;55:27–39. doi:10.1016/j.brat.2014.01.007.
Olsson EM, El Alaoui S, Carlberg B, Carlbring P, Ghaderi A. Internet-based biofeedback-assisted relaxation training in the treatment of hypertension: a pilot study. Appl Psychophysiol Biofeedback. 2010;35(2):163–70. doi:10.1007/s10484-009-9126-x.
Ström L, Pettersson R, Andersson G. A controlled trial of self-help treatment of recurrent headache conducted via the internet. J Consult Clin Psychol. 2000;68(4):722–7. doi:10.1037//0022-006X.68.4.722.
Krusche A, Cyhlarova E, King S, Williams JMG. Mindfulness online: a preliminary evaluation of the feasibility of a web-based mindfulness course and the impact on stress. BMJ Open. 2012;2(3):e000803. doi:10.1136/bmjopen-2011-000803.
Krusche A, Cyhlarova E, Williams JMG. Mindfulness online: an evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open. 2013;3(11):e003498. doi:10.1136/bmjopen-2013-003498.
Cavanagh K, Strauss C, Cicconi F, Griffiths N, Wyper A, Jones F. A randomised controlled trial of a brief online mindfulness-based intervention. Behav Res Ther. 2013;51(9):573–8. doi:10.1016/j.brat.2013.06.003.
Glück TM, Maercker A. A randomized controlled pilot study of a brief web-based mindfulness training. BMC Psychiatry. 2011;11(1):175. doi:10.1186/1471-244X-11-175.
Reid DT. Teaching mindfulness to occupational therapy students: pilot evaluation of an online curriculum. Can J Occup Ther. 2013;80(1):42–8. doi:10.1177/0008417413475598.
Dimidjian S, Beck A, Felder JN, Boggs JM, Gallop R, Segal ZV. Web-based mindfulness-based cognitive therapy for reducing residual depressive symptoms: an open trial and quasi-experimental comparison to propensity score matched controls. Behav Res Ther. 2014;63:83–9. doi:10.1016/j.brat.2014.09.004.
Del Re A, Flückiger C, Horvath AO, Symonds D, Wampold BE. Therapist effects in the therapeutic alliance–outcome relationship: a restricted-maximum likelihood meta-analysis. Clin Psychol Rev. 2012;32(7):642–9. doi:10.1016/j.cpr.2012.07.002.
Horvath AO, Symonds BD. Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Couns Psychol. 1991;38(2):139.
Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta-analysis. World Psychiatry. 2014;13(3):288–95. doi:10.1002/wps.20151.
Wagner B, Horn AB, Maercker A. Internet-based versus face-to-face cognitive-behavioral intervention for depression: a randomized controlled non-inferiority trial. J Affect Disord. 2014;152:113–21. doi:10.1016/j.jad.2013.06.032.
Lappalainen P, Granlund A, Siltanen S, Ahonen S, Vitikainen M, Tolvanen A, et al. ACT Internet-based vs face-to-face? A randomized controlled trial of two ways to deliver Acceptance and Commitment Therapy for depressive symptoms: an 18-month follow-up. Behav Res Ther. 2014;61:43–54. doi:10.1016/j.brat.2014.07.006.
Spek V, Cuijpers P, NyklÃcek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007;37(03):319–28. doi:10.1017/S0033291706008944.
Mohr DC, Siddique J, Ho J, Duffecy J, Jin L, Fokuo JK. Interest in behavioral and psychological treatments delivered face-to-face, by telephone, and by internet. Ann Behav Med. 2010;40(1):89–98. doi:10.1007/s12160-010-9203-7.
Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res. 2006;8(2):e10. doi:10.2196/jmir.8.2.e10.
Gagneja APS, Gagneja KK, editors. Mobile health (mHealth) technologies. 2015 17th International Conference on E-health Networking, Application & Services (HealthCom); 2015: IEEE.
Buhrman M, Skoglund A, Husell J, Bergström K, Gordh T, Hursti T, et al. Guided internet-delivered acceptance and commitment therapy for chronic pain patients: a randomized controlled trial. Behav Res Ther. 2013;51(6):307–15. doi:10.1016/j.brat.2013.02.010.
Hesser H, Gustafsson T, Lundén C, Henrikson O, Fattahi K, Johnsson E, et al. A randomized controlled trial of Internet-delivered cognitive behavior therapy and acceptance and commitment therapy in the treatment of tinnitus. J Consult Clin Psychol. 2012;80(4):649–61. doi:10.1037/a0027021.
Trompetter HR, Bohlmeijer ET, Veehof MM, Schreurs KM. Internet-based guided self-help intervention for chronic pain based on acceptance and commitment therapy: a randomized controlled trial. J Behav Med. 2015;38(1):66–80. doi:10.1007/s10865-014-9579-0.
Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guilford Press; 1999.
Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25. doi:10.1016/j.brat.2005.06.006.
Carmody J, Baer RA. Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program. J Behav Med. 2008;31(1):23–33. doi:10.1007/s10865-007-9130-7.
De Vibe M, Bjørndal A, Tipton E, Hammerstrøm KT, Kowalski K. Mindfulness based stress reduction (MBSR) for improving health, quality of life, and social functioning in adults. Campbell Syst Rev. 2012; 8(3). doi:10.4073/csr.2012.3.
Cuijpers P, Van Straten A, Andersson G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J Behav Med. 2008;31(2):169–77. doi:10.1007/s10865-007-9144-1.
Research2Guidance. mHealth App Developer Economics 2015: The current status and trends of the mHealth app market. 2015. www.research2guidance.com. Accessed March 17, 2016.
Acknowledgments
The authors acknowledge and thank for the contribution of Iara Meili, who supported the screening process.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was funded by the Swiss Cancer League (funding ID: KLS-3564-02-2015).
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
This article does not contain any studies with human participants performed by any of the authors.
Appendix
Appendix
Search strategy for EBSCO (PsycINFO, CINAHL, AMED)
(
TI (app OR mobile OR web OR online OR internet OR phone OR smart-phone OR smartphone OR cellphone OR cell-phone OR computer)
OR
AB (app OR mobile OR web OR online OR internet OR phone OR smart-phone OR smartphone OR cellphone OR cell-phone OR computer)
)
AND
(
TI (mindfulness OR meditat* OR stress-reduc* OR stress-manag* OR mind-body* OR breath* OR relax*)
OR
AB (mindfulness OR meditat* OR stress-reduc* OR stress-manag* OR mind-body* OR breath* OR relax* OR mbsr OR kabat zinn)
)
AND
(
TI (intervention OR rct OR (random* N3 trial*) OR treatment OR training OR exerci* OR practice OR clinical trial*)
OR
AB (intervention OR rct OR (random* N3 trial*) OR treatment OR training OR exerci* OR practice OR clinical trial*)
)
NOT
(
TI (abuse OR alcohol OR addiction OR smok* OR carbon* OR (acute N2 respiratory) OR asthma)
ORAB (abuse OR alcohol OR addiction OR smok* OR carbon* OR (acute N2 respiratory) OR asthma)
)
Limiters:
Date: January 1, 1990–April 7, 2015, 22:00
Source type: academic journals, journals, dissertations
Number of hits, 924
Duplicates found by EBSCOhost, 69
Number of unique hits, 855
Rights and permissions
About this article
Cite this article
Mikolasek, M., Berg, J., Witt, C.M. et al. Effectiveness of Mindfulness- and Relaxation-Based eHealth Interventions for Patients with Medical Conditions: a Systematic Review and Synthesis. Int.J. Behav. Med. 25, 1–16 (2018). https://doi.org/10.1007/s12529-017-9679-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12529-017-9679-7