Emotion-Related Constructs Engaged by Mindfulness-Based Interventions: a Systematic Review and Meta-analysis

Hoge, Elizabeth A.; Acabchuk, Rebecca L.; Kimmel, Hannah; Moitra, Ethan; Britton, Willoughby B.; Dumais, Travis; Ferrer, Rebecca A.; Lazar, Sara W.; Vago, David; Lipsky, Jonah; Schuman-Olivier, Zev; Cheaito, Aya; Sager, Lauren; Peters, Sarah; Rahrig, Hadley; Acero, Pamela; Scharf, Jodi; Loucks, Eric B.; Fulwiler, Carl

doi:10.1007/s12671-020-01561-w

REVIEW
Published: 26 November 2020

Emotion-Related Constructs Engaged by Mindfulness-Based Interventions: a Systematic Review and Meta-analysis

Elizabeth A. Hoge¹,
Rebecca L. Acabchuk²,
Hannah Kimmel³,
Ethan Moitra ORCID: orcid.org/0000-0003-0801-6552^4,5,
Willoughby B. Britton^3,4,
Travis Dumais³,
Rebecca A. Ferrer⁶,
Sara W. Lazar⁷,
David Vago⁸,
Jonah Lipsky³,
Zev Schuman-Olivier⁹,
Aya Cheaito^3,4,
Lauren Sager³,
Sarah Peters³,
Hadley Rahrig³,
Pamela Acero³,
Jodi Scharf³,
Eric B. Loucks³ &
Carl Fulwiler^9,10

Mindfulness volume 12, pages 1041–1062 (2021)Cite this article

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Abstract

Objectives

Mindfulness-based interventions (MBIs) have been widely implemented to improve self-regulation behaviors, often by targeting emotion-related constructs to facilitate change. Yet the degree to which MBIs engage specific measures of emotion-related constructs has not been systematically examined.

Methods

Using advanced meta-analytic techniques, this review examines construct and measurement engagement in trials of adults that used standardized applications of the two most established MBIs: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), or modified variations of these interventions that met defined criteria.

Results

Seventy-two studies (N = 7,378) were included (MBSR k = 47, MBCT k = 21, modified k = 4). MBIs led to significant improvement in emotion-related processing overall, compared to inactive controls (d = 0.58; k = 36), and in all constructs assessed: depression (d = 0.66; k = 26), anxiety (d = 0.63; k = 19), combined mental health (d = 0.75; k = 7), and stress (d = 0.44; k = 11). Reactions to pain, mood states, emotion regulation, and biological measures lacked sufficient data for analysis. MBIs did not outperform active controls in any analyses. Measurement tool and population type did not moderate results, but MBI type did, in that MBCT showed stronger effects than MBSR, although these effects were driven by a small number of studies.

Conclusions

This review is the first to examine the full scope of emotion-related measures relevant to self-regulation, to determine which measures are most influenced by MBCT/MBSR. Compared to extant reviews, which typically focused on MBI outcomes, this work examined mechanistic processes based on measurement domains and tools. While effect sizes were similar among measurement tools, this review also includes a descriptive evaluation of measures and points of caution, providing guidance to MBI researchers and clinicians for selection of emotion-related measurement tools.

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*Denotes study included in the systematic review and meta-analyses.

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Acknowledgments

We thank Blair T. Johnson and Emily A. Hennessy for their methodological advice. We also would like to thank Ana Alejandre-Lara for her work on the figures and manuscript preparation.

Funding

This work was supported by the National Institutes of Health (NIH) Science of Behavior Change Common Fund Program through an award administered by the National Center for Complementary and Integrative Health (grant UH2AT009145). W.B.B. received funding from NIH grant K23AT006328-01A1. The views presented here are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Department of Psychiatry, Georgetown University School of Medicine, 2115 Wisconsin Ave NW Suite 200, Washington, DC, 20007, USA
Elizabeth A. Hoge
Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
Rebecca L. Acabchuk
School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA
Hannah Kimmel, Willoughby B. Britton, Travis Dumais, Jonah Lipsky, Aya Cheaito, Lauren Sager, Sarah Peters, Hadley Rahrig, Pamela Acero, Jodi Scharf & Eric B. Loucks
Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, 700 Butler Dr, Providence, RI, 02906, USA
Ethan Moitra, Willoughby B. Britton & Aya Cheaito
Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
Ethan Moitra
Basic Biobehavioral and Psychological Sciences Branch, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892, USA
Rebecca A. Ferrer
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
Sara W. Lazar
Osher Center for Integrative Medicine, Vanderbilt University, 3401 West End Avenue, Suite 380, Nashville, TN, 37203, USA
David Vago
Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge St, Cambridge, MA, 02139, USA
Zev Schuman-Olivier & Carl Fulwiler
Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
Carl Fulwiler

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Conflict of Interest

E.B.L. is Director of the Mindfulness Center at Brown University. The Mindfulness Center, a non-profit entity, has an Education Unit that provides mindfulness-based program delivery to the general public for fees. However, E.B.L.’s salary is not tied to quantity or content of programs offered through the Mindfulness Center. W.B.B. is a MBSR and MBCT teacher and has received financial compensation for this role. W.B.B. receives payments for providing trainings and education in scientific literacy, meditation safety, and trauma-informed mindfulness. W.B.B. is nominally affiliated with the Mindfulness Center at Brown University which generates income by offering mindfulness classes to the public; W.B.B. does not receive any financial compensation from the Mindfulness Center. The other authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Hoge, E.A., Acabchuk, R.L., Kimmel, H. et al. Emotion-Related Constructs Engaged by Mindfulness-Based Interventions: a Systematic Review and Meta-analysis. Mindfulness 12, 1041–1062 (2021). https://doi.org/10.1007/s12671-020-01561-w

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Accepted: 12 November 2020
Published: 26 November 2020
Issue Date: May 2021
DOI: https://doi.org/10.1007/s12671-020-01561-w

Keywords

Mindfulness
Affect regulation
Emotion
Measurement tools