Mindfulness-based intervention (MBI) has at least a short-term positive effect for university students not initiating MBI based on a specific mental health diagnosis, according to results of a meta-analysis of 51 randomized controlled trials (RCTs) recently published inApplied Psychology: Health and Well-Being. Because of potential for bias in RCTs, especially behavioral-therapy RCTs, further research is warranted to determine the effect of MBI on mental health variables in university-aged students.

The mental health and well-being of university students is a clinically important issue as they are considered to be a high-risk population for mental health disorders such as distress, anxiety, and depression. Attending higher education institutions usually entails a change to a new living environment and the additional stresses of a new educational setting, with greater demands as well as new social pressures, which can cause or exacerbate mental health issues.

The incidence of students requesting support each year from university counseling services has increased, according to research published by the Institute for Employment Studies and Research Equity. In response to this, more universities are offering MBI to students.

Mindfulness has garnered significant attention within psychological literature and clinical practice, Dawson and colleagues wrote. Current theoretical frameworks suggest that mindfulness training operates by producing changes in the structure and function of brain regions involved in attentional control, emotional regulation, sensory awareness, and self-awareness. In contrast, relaxation training has effect via regulation of inhibition and control, differing from the more diffuse cognitive functions engaged by MBI.

Studies investigating the effect of MBI are ongoing, and a variety of methods and durations of administration have been implemented. To provide a comprehensive overview of the current evidence on MBI for researchers and university policy-makers to enable more informed decisions, a series of meta-analyses were conducted.

Investigators performed a systematic search of research databases, literature databases, and the World Health Organization clinical trial registry to identify any RCTs focused on MBI. Overall, they used 9 databases to determine 51 RCTs for inclusion. The RCTs included in the study had been conducted in 15 different countries between 1988 and 2017 and involved various MBI practices. Of these, 22% were based on self-help rather than instructor led, and duration varied from single-session studies in a laboratory setting to multipart interventions in general campus settings, conducted over a 10-week period. The most common intervention length was 8 weeks. The outcome variables used for the meta-analysis were mental and physical health because of a paucity of data on health service use and academic performance. Researchers grouped results using 4 domains, described below.

Mental Ill-Health Outcomes:Meta-analyses revealed that distress was significantly reduced postintervention in study participants who received MBI, and prediction intervals based on compiled data indicated that MBI will reduce distress in at least 95% of MBI administration scenarios. A meta-regression, inclusive of 17 studies and 1842 participants, did not demonstrate a significant influence of intervention duration on postintervention distress level.

In a meta-analysis examining follow-up distress, findings were significant in favor of MBI. Of note, these data did not change after removing lower-quality trials or after removal of the 1-cluster RCTs included.

In addition to distress, anxiety was also significantly reduced among participants who underwent MBI, relative to both passive and active controls; however, prediction interval analysis indicated that MBI generally reduces state anxiety in some cases but may increase it in others. Outcomes did not specifically favor either MBIs or passive controls for the variable of worry, and the studies were not large enough to justify a subgroup analysis.

Positive Psychological Functioning Outcomes:Relative to passive controls, participants who underwent MBI experienced significantly increased trait mindfulness postintervention, although researchers noted substantial heterogeneity of effect sizes. They further explored this by separate analyses of 2 outcome instruments (Mindfulness Awareness Attention Scale and Five Facet Mindfulness Questionnaire).The analysis still showed significance in favor of MBI, although high levels of heterogeneity remained. Postintervention measures of self-compassion significantly favored MBI compared with passive controls; however, similar to anxiety, prediction intervals indicated that MBI will increase self-compassion in some scenarios and reduce it in others.

Well-Being Outcomes.A postintervention measure of life satisfaction did not differ significantly in favor of MBI in the overall meta-analysis; however, a sensitivity analysis excluding cluster-RCTs did show significance for MBI over passive control.

Physical Health Outcomes.The outcome measure of sleep impairment was not significantly decreased after MBI compared with passive control, and substantial heterogeneity was noted within the study groups for this variable as well. No significant differences between MBI and control were shown for systolic or diastolic blood pressure.

Psychological distress has previously been identified within literature as a focal point of mental health discussions within university-based populations, according to Williams and colleagues of the Institute for Employment Studies in Brighton, England, United Kingdom. They further stated that there is a need to help students reap the positive mental health benefits of higher education and identifying students who may be struggling and providing appropriate support. The potential value of the mindfulness-based programs provided by higher education institutions throughout the United Kingdom, listed in their report, is supported by the findings of the meta-analysis on MBI, which corroborated overall efficacy of MBI programs for university students in some critical mental-health-related outcomes.1,2

When comparing course-based MBI with passive controls, MBI significantly reduced levels of distress, depression, anxiety, and rumination, and increased well-being within university students when measured at post-intervention, reported Dawson and colleagues. They also noted longer-term reductions in distress, as measured by follow-up assessments.

Other studies on MBI that were not focused on university populations have identified ways in which MBI can help. One review, focused more specifically on anxiety and depression, found that MBI therapies perform comparably to cognitive-behavioral therapy; the treatment modalities have compatible treatment principles.

Another review, published in 2018, noted that despite its longstanding history, MBIs have only been incorporated in Western medicine and culture since the late 20th century. Despite this, considerable support has been amassed for the practice.

Despite these widespread positives, Dawson and colleagues cautioned that the findings from their meta-analysis were, in fact, highly heterogenous and that this raises questions about the overall operationalization of mindfulness, adding that more homogenous effects of mindfulness interventions should have been seen.

Although many positives of MBIs have been noted, the researchers cautioned that they may, in some students, create a sense of discomfort or unease: a phenomenon confirmed in the literature as well.5,6 These instances may require either focused individual attention from the course leader if in a group setting or support from other specialized services if it occurs from self-led MBI practice.

Overall, this review found some evidence that MBIs are effective for promoting mental health in the average student, Dawson and colleagues wrote, [h]owever, the low methodological quality of most of the included trials precludes making firm recommendations for practice.

Some students in some contexts may not benefit from the effects of mindfulness interventions. Institutions who are seeking to establish these practices should research the benefits, harms, and variability of effects before moving forward.

Future research directions include assessment of outcomes related to academic and mental health services. Data from RCTs included in the meta-analysis were insufficient to assess these outcomes, and thus RCTs within these categories should be conducted.

In addition, the potential for differences in effect between self-help and instructor-led MBIs should be explored. Although self-help interventions may be more cost-effective and easier to implement, this setting may ultimately limit the detection of potential adverse effects. In general, the potential adverse effects, be they mild or severe, of MBIs require additional attention from both researchers and mental health care providers.

Ultimately, this work shows that MBIs could have beneficial effects when implemented within a general university population, Dawson and colleagues concluded, however, higher quality research is needed to define their active components, long-term effects, effectiveness compared to other programs, optimal format and delivery, cultural variability, and safety profile.

References

1. Dawson AF, Brown WW, Anderson J, et al.Mindfulness-based interventions for university students: A systematic review and meta-analysis of randomised controlled trials[published online November 19, 2019].Appl Psychol Health Well Being.doi:10.1111/aphw.12188

2. Williams M, Coare P, Marvell R, Pollard E, Houghton A-M, Anderson J.Understanding provision for students with mental health problems and intensive support needs: Report to HEFCE by the Institute for Employment Studies (IES) and Researching Equity, Access and Partnership (REAP). Brighton, England, UK: Institute for Employment Studies; 2015. Accessed December 5, 2019.

3. Hofmann SG, Gmez AF.Mindfulness-based interventions for anxiety and depression.Psychiatr Clin North Am.2017;40(4):739-749.

4. Shapero BG, Greenberg J, Pedrelli P, de Jong M, Desbordes G.Mindfulness-based interventions in psychiatry.Focus (Am Psychiatr Publ).2018;16(1):32-39.

5. Burrows L.Safeguarding mindfulness meditation for vulnerable college students.Mindfulness.2016;7(7):284-285.

6. Cebolla A, Demarzo M, Martins P, Soler J, Garcia-Campayo J.Unwanted effects: Is there a negative side of meditation? A multicenter survey.PLoS One.2016;12(9):e0183137.

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Mindfulness-Based Meditation and Higher Education - Psychiatry Advisor