DOI: 10.3724/SP.J.1041.2018.00283

Acta Psychologica Sinica (心理学报) 2018/50:3 PP.283-305

Effectiveness of mindfulness meditation in intervention for anxiety:A meta-analysis

Mindfulness meditation (MM) has enjoyed a growing popularity in healthcare in recent years when bio-psycho-social approaches are becoming more and more emphasized in modern medicine. There has been mounting empirical evidence showing MM's significant effectiveness in alleviating anxiety for both nonclinical and clinical populations. However, the effect size of the available empirical investigation results has remained inconsistent and possible moderators have yet to be explored comprehensively. In order to determine the immediate and long-term efficacy of MM in overcoming anxiety, we conducted a meta-analysis based on a systematic and comprehensive review of the published studies on mindfulness-based interventions for anxiety. We also examined whether some characteristics of research participants (e.g. age, geographic areas) and interventions (e.g. format, duration, at-home practice), and specifics of the study (i.e. types of control, quality of the study) and data analysis (e.g. attrition rate) moderate the magnitude of the effectiveness of MM interventions (11variables).
The review was performed following the rigorous PRISMA Protocol. Published studies using randomized controlled trial were selected from major databases worldwide to include investigations conducted in both Western and Eastern countries. Databases used include VIP Journal Integration Platform, Wan fang, China National Knowledge Infrastructure, Scopus, Web of Science, Embase, the Cochrane Library, and PubMed. Keywords used are mindfulness, meditation, MBSR, MBCT, anxi*, mood, intervention, therapy, program. Using the random effect model, we pooled the effect size (Hedge's g), and conducted a publication bias evaluation, a moderating effect analysis and an interaction analysis in CMA 3.3.
Results of our analyses revealed fifty-five RCTs from both Eastern and Western countries (k=68 samples, N=4595 participants). Mindfulness meditation for treating anxiety is shown to be efficacious with a medium to large immediate effect (g=0.60), but the effect is not reliably shown at follow-up assessments. The post-heterogeneity test result suggests that using the random effect model is reasonable. Univariate meta-regression analysis yielded that study quality, geographic areas, participants' age, intervention format (Group vs. Individual), amount of at-home practice, and attrition rate shown in data analysis remarkably influenced the effect size of MM's immediate effect, while types of control, health condition, mindfulness practice experience, intervention duration, or statistical analysis methods used (ITT vs. PP) did not appear to moderate MM's immediate effectiveness for reducing anxiety. Additionally, geographic areas affect the effect size the most. Multiple meta-regression models suggested that type of control and geographic areas, as well as statistical analysis methods significantly moderate the effect size of intervention effectiveness.
Overall, the study results demonstrated high immediate effect of mindfulness-based practices for alleviating anxiety, but the effect did not seem to last. In addition, geographic area turns out to be the strongest moderator, and practitioners in the East seem to benefit more than those who are in the West. Study quality, participants' age, mindfulness practice experience, intervention format, at-home practice quantity and attrition rate also affect the effect size to a certain extent. Future research is warranted to improve methodological quality of outcome studies, to provide more clear and replicable evidence of MM efficacy, and to explore more underlying moderators for the intervention effect size, such as participant satisfaction and so forth.

Key words:mindfulness meditation,anxiety,intervention,moderating effect,cultural differences,meta-analysis

ReleaseDate:2018-03-29 16:23:27

Akobeng, A. K. (2005). Principles of evidence based medicine. Archives of Disease in Childhood, 90(8), 837-840.

Armijo-Olivo, S., Stiles, C. R., Hagen, N. A., Biondo, P. D., & Cummings, G. G. (2012). Assessment of study quality for systematic reviews:a comparison of the cochrane collaboration risk of bias tool and the effective public health practice project quality assessment tool:methodological research. Journal of Evaluation in Clinical Practice, 18(1), 12-18.

Bamber, M. D., & Schneider, J. K. (2016). Mindfulness-based meditation to decrease stress and anxiety in college students:A narrative synthesis of the research. Educational Research Review, 18, 1-32.

Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van IJzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals:A meta-analytic study. Psychological Bulletin, 133(1), 1-24.

Benn, R., Akiva, T., Arel, S., & Roeser, R. W. (2012). Mindfulness training effects for parents and educators of children with special needs. Developmental Psychology, 48(5), 1476-1487.

Berkeljon, A., & Baldwin, S. A. (2009). An introduction to meta-analysis for psychotherapy outcome research. Psychotherapy Research, 19(4-5), 511-518.

Black, D. S., O'Reilly, G. A., Olmstead, R., Breen, E. C., & Irwin, M. R. (2015). Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances. JAMA Internal Medicine, 175(4), 494-501.

Boettcher, J., Åström, V., Påhlsson, D., Schenström, O., Andersson, G., & Carlbring, P. (2014). Internet-based mindfulness treatment for anxiety disorders:A randomized controlled trial. Behavior Therapy, 45(2), 241-253.

Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2005). Comprehensive meta-analysis (version 3. 3) (p. 104). Englewood, NJ:Biostat.

Borenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2009). Introduction to meta-analysis. Chichester, UK:Wiley.

Bränström, R., Kvillemo, P., & Moskowitz, J. T. (2012). A randomized study of the effects of mindfulness training on psychological well-being and symptoms of stress in patients treated for cancer at 6-month follow-up. International Journal of Behavioral Medicine, 19(4), 535-542.

Britton, W. B., Lepp, N. E., Niles, H. F., Rocha, T., Fisher, N. E., & Gold, J. S. (2014). A randomized controlled pilot trial of classroom-based mindfulness meditation compared to an active control condition in sixth-grade children. Journal of School Psychology, 52(3), 263-278.

Brouwers, M. C., Johnston, M. E., Charette, M. L., Hanna, S. E., Jadad, A. R., & Browman, G. P. (2005). Evaluating the role of quality assessment of primary studies in systematic reviews of cancer practice guidelines. BMC Medical Research Methodology, 5, 8.

Brown, K. W., & Kasser, T. (2005). Are psychological and ecological well-being compatible? The role of values, mindfulness, and lifestyle. Social Indicators Research, 74(2), 349-368.

Cao, H. T., & Zhang, W. (2014a). Effects of mindfulness behavior training on mood states and quality of life in old patients post fixation for hip fracture. Chinese Journal of Rehabilitation Theory and Practice, 20(9), 881-884.

[曹海涛, 张婉. (2014a). 短期正念行为训练对髋部骨折固定术后老年患者心境状态及生活质量的影响. 中国康复理论与实践, 20(9), 881-884.]

Cao, H. T., & Zhang, W. (2014b). Effects of mindfulness behavior training on emotional disorder and immunological function in elderly patients after hip fracture fixation surgery. Chinese Journal of Physical Medicine and Rehabilitation, 36(10), 774-777.

[曹海涛, 张婉. (2014b). 短期正念行为训练对髋部骨折固定术后老年患者负性情绪及免疫功能的影响. 中华物理医学与康复杂志, 36(10), 774-777.]

Cao, H. T., & Zhang, W. (2014c). Effects of mindfulness training on functional recovery in elderly patients with hip fracture after fixation. Chinese General Practice, 17(20), 2374-2377.

[曹海涛, 张婉. (2014c). 正念行为训练对老年髋部骨折固定术后患者功能恢复的影响研究. 中国全科医学, 17(20), 2374-2377.]

Cavanagh, K., Strauss, C., Forder, L., & Jones, F. (2014). Can mindfulness and acceptance be learnt by self-help?:A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review, 34(2), 118-129.

Chen, K. W., Berger, C. C., Manheimer, E., Forde, D., Magidson, J., Dachman, L., & Lejuez, C. W. (2012). Meditative therapies for reducing anxiety:A systematic review and meta-analysis of randomized controlled trials. Depression and Anxiety, 29(7), 545-562.

Chen, Y., Yang, X. L., Wang, L. Y., & Zhang, X. Y. (2013). A randomized controlled trial of the effects of brief mindfulness meditation on anxiety symptoms and systolic blood pressure in Chinese nursing students. Nurse Education Today, 33(10), 1166-1172.

Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches:Are they all the same?. Journal of Clinical Psychology, 67(4), 404-424.

Chiesa, A., Mandelli, L., & Serretti, A. (2012). Mindfulness-based cognitive therapy versus psycho-education for patients with major depression who did not achieve remission following antidepressant treatment:A preliminary analysis. The Journal of Alternative and Complementary Medicine, 18(8), 756-760.

Chiesa, A., & Serretti, A. (2010). A systematic review of neurobiological and clinical features of mindfulness meditations. Psychological Medicine, 40(8), 1239-1252.

Chiesa, A., & Serretti, A. (2011). Mindfulness based cognitive therapy for psychiatric disorders:A systematic review and meta-analysis. Psychiatry Research, 187(3), 441-453.

Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety:A global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.

Chu, I. H., Lin, Y. J., Wu, W. L., Chang, Y. K., & Lin, I. M. (2015). Effects of yoga on heart rate variability and mood in women:A randomized controlled trial. The Journal of Alternative and Complementary Medicine, 21(12), 789-795.

Cramer, H., Rabsilber, S., Lauche, R., Kümmel, S., & Dobos, G. (2015). Yoga and meditation for menopausal symptoms in breast cancer survivors-A randomized controlled trial. Cancer, 121(13), 2175-2184.

Creswell, J. D. (2017). Mindfulness interventions. Annual Review of Psychology, 68, 491-516.

Danucalov, M. A. D., Kozasa, E. H., Ribas, K. T., Galduróz, J. C. F., Garcia, M. C., Verreschi, I. T. N.,... Leite, J. R. (2013). A yoga and compassion meditation program reduces stress in familial caregivers of Alzheimer's disease patients. Evidence-Based Complementary and Alternative Medicine, 2013, Article ID 513149.

Davis, K., Goodman, S. H., Leiferman, J., Taylor, M., & Dimidjian, S. (2015). A randomized controlled trial of yoga for pregnant women with symptoms of depression and anxiety. Complementary Therapies in Clinical Practice, 21(3), 166-172.

Davis, L., & Kurzban, S. (2012). Mindfulness-based treatment for people with severe mental illness:A literature review. American Journal of Psychiatric Rehabilitation, 15(2), 202-232.

Demarzo, M. M. P., Montero-Marin, J., Cuijpers, P., Zabaleta-del-Olmo, E., Mahtani, K. R., Vellinga, A.,... García-Campayo, J. (2015). The efficacy of mindfulness-based interventions in primary care:A meta-analytic review. The Annals of Family Medicine, 13(6), 573-582.

Djikic, M. (2014). Art of mindfulness:Integrating eastern and western approaches. In A. Ie, C. T. Ngnoumen, & E. J. Langer (Eds.), The wiley blackwell handbook of mindfulness (pp. 139-148). Oxford, U. K.:John Wiley & Sons Ltd.

Eberth, J., & Sedlmeier, P. (2012). The effects of mindfulness meditation:A meta-analysis. Mindfulness, 3(3), 174-189.

Ebnezar, J., Nagarathna, R., Yogitha, B., & Nagendra, H. R. (2012). Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint:A randomized control study. International Journal of Yoga, 5(1), 28-36.

Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109), 629-634.

Ford, M. T., Cerasoli, C. P., Higgins, J. A., & Decesare, A. L. (2011). Relationships between psychological, physical, and behavioural health and work performance:A review and meta-analysis. Work & Stress, 25, 185-204.

Geiger, P. J., Boggero, I. A., Brake, C. A., Caldera, C. A., Combs, H. L., Peters, J. R., & Baer, R. A. (2016). Mindfulness-based interventions for older adults:A review of the effects on physical and emotional well-being. Mindfulness, 7(2), 296-307.

Gerbarg, P. L., Jacob, V. E., Stevens, L., Bosworth, B. P., Chabouni, F., DeFilippis, E. M.,... Scherl, E. J. (2015). The effect of breathing, movement, and meditation on psychological and physical symptoms and inflammatory biomarkers in inflammatory bowel disease. Inflammatory Bowel Diseases, 21(12), 2886-2896.

Germer, C. K. (2005a). Anxiety disorders:Befriending fear. In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 152-172). New York, NY, US:The Guilford Press.

Germer, C. K. (2005b). Mindfulness:What is it? What does it matter?. In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds.), Mindfulness and psychotherapy (pp. 3-28). London:The Guilford Press.

Gotink, R. A., Chu, P., Busschbach, J. J. V., Benson, H., Fricchione, G. L., & Hunink, M. G. M. (2015). Standardised mindfulness-based interventions in healthcare:An overview of systematic reviews and meta-analyses of RCTs. PLoS One, 10(4), e124344.

Goyal, M., Singh, S., Sibinga, E. M. S., Gould, N. F., Rowland-Seymour, A., Sharma, R.,... Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being:A systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357-367.

Guardino, C. M., Schetter, C. D., Bower, J. E., Lu, M. C., & Smalley, S. L. (2014). Randomised controlled pilot trial of mindfulness training for stress reduction during pregnancy. Psychology & Health, 29(3), 334-349.

Guo, X. J. (2015). Influence of mindfulness decompression therapy on decompensated liver cirrhosis anti-virus treatment and patients' negative emotions. China Pharmaceuticals, 24(24), 119-120.

[郭小君. (2015). 正念减压疗法对失代偿期抗病毒治疗患者负性情绪的影响. 中国药业, 24(24), 119-120.]

Gupta, S. (2011). Intention-to-treat concept:A review. Perspectives in Clinical Research, 2(3), 109-112.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy:Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1-25.

Higgins, J. P. T., & Green, S. (2011). Cochrane Handbook for systematic reviews of interventions. Version 5. 1. 0. Chichester:John Wiley & Sons Ltd.

Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression:A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.

Hoge, E. A., Bui, E., Marques, L., Metcalf, C. A., Morris, L. K., Robinaugh, D. J.,... Simon, N. M. (2013). Randomized controlled trial of mindfulness meditation for generalized anxiety disorder. The Journal of Clinical Psychiatry, 74(8), 786-792.

Huedo-Medina, T. B., Sánchez-Meca, J., Marín-Martínez, F., & Botella, J. (2006). Assessing heterogeneity in meta-analysis:Q statistic or I2 index? Psychological Methods, 11(2), 193-206.

Hwang, J. H., Kim, W. Y., Ahmed, M., Choi, S., Kim, J., & Han, D. W. (2015). The use of complementary and alternative medicine by Korean breast cancer women:Is it associated with severity of symptoms? Evidence-Based Complementary and Alternative Medicine, 2015, Article ID 182475.

Iglesias, S. L., Azzara, S., Argibay, J. C., Arnaiz, M. L., de Valle Carpineta, M., Granchetti, H., & Lagomarsino, E. (2012). Psychological and physiological response of students to different types of stress management programs. American Journal of Health Promotion, 26(6), e149-e158.

Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J. M., Gavaghan, D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomized clinical trials:is blinding necessary?. Controlled Clinical Trials, 17(1), 1-12.

Johns, S. A., Brown, L. F., Beck-Coon, K., Monahan, P. O., Tong, Y., & Kroenke, K. (2015). Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psycho-Oncology, 24(8), 885-893.

Josefsson, T., Lindwall, M., & Broberg, A. G. (2014). The effects of a short-term mindfulness based intervention on self-reported mindfulness, decentering, executive attention, psychological health, and coping style:Examining unique mindfulness effects and mediators. Mindfulness, 5(1), 18-35.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context:Past, present, and future. Clinical Psychology:Science and Practice, 10(2), 144-156.

Kallapiran, K., Koo, S., Kirubakaran, R., & Hancock, K. (2015). Review:Effectiveness of mindfulness in improving mental health symptoms of children and adolescents:A meta-analysis. Child and Adolescent Mental Health, 20(4), 182-194.

Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance:A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755-772.

Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1-27.

Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V.,... Hofmann, S. G. (2013). Mindfulness-based therapy:A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763-771.

Khoury, B., Sharma, M., Rush, S. E., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals:A meta-analysis. Journal of Psychosomatic Research, 78(6), 519-528.

Kim, Y. H., Kim, H. J., Ahn, S. D., Seo, Y. J., & Kim, S. H. (2013). Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer. Complementary Therapies in Medicine, 21(4), 379-387.

la Cour, P., & Petersen, M. (2015). Effects of mindfulness meditation on chronic pain:A randomized controlled trial. Pain Medicine, 16(4), 641-652.

Lakhan, S. E., & Schofield, K. L. (2013). Mindfulness-based therapies in the treatment of somatization disorders:A systematic review and meta-analysis. PLoS One, 8(8), e71834.

Lazar, S. W. (2005). Mindfulness research. In C. K. Germer, R. D. Siegel, & P. R. Fulton (Eds). Mindfulness and psychotherapy (pp. 220-238). New York, NY, US:The Guilford Press.

Lever Taylor, B., Cavanagh, K., & Strauss, C. (2016). The effectiveness of mindfulness-based interventions in the perinatal period:A systematic review and meta-analysis. PLoS One, 11(5), e155720.

Li, L., Liu, Y., Yuan, L., Zhang, J., & Du, C. Y. (2015). Effects of mindfulness meditation on stress reaction of patients with gynecologic tumor operation. Progress in Modern Biomedicine, 15(16), 3129-3131.

[李琳, 刘颖, 袁琳, 张锦, 杜丛研. (2015). 正念冥想对妇科肿瘤手术患者应激反应的影响. 现代生物医学进展, 15(16), 3129-3131.]

Liang, F. Z., Zhang, F. Y., Cai, Y. Y., Qin, Y. L., & Li, Y. H. (2015). Influence of meditation and relax training on anxiety-depression of schizophrenia patients. Clinical Medicine & Engineering, 22(5), 622-623.

[梁凤珍, 张凤英, 蔡燕玉, 覃远丽, 李燕红. (2015). 冥想与放松训练对精神分裂症患者焦虑抑郁情绪的影响. 临床医学工程, 22(5), 622-623.]

Liu, S. Y., Huang, L., Yang, S. M., Qin, J., & Song, S. P. (2015). Meditation training ameliorates nursing efficacy for endoscopic retrograde cholangiopancreatography (ERCP). International Journal of Nursing, 34(2), 239-241.

[刘淑艳, 黄岚, 杨淑敏, 秦杰, 宋淑平. (2015). 冥想训练改善经内镜逆行胰胆管造影患者的护理效果. 国际护理学杂志, 34(2), 239-241.]

Ma, X. L., Jiang, W. L., & Ou, L. C. (2015). The effectiveness of psychological intervention of mindfulness based stress reduction on stress reaction for selective operation patients. Journal of Nursing Administration, 15(9), 656-658.

[马雪莲, 蒋维连, 欧丽嫦. (2015). 基于正念减压疗法的心理干预对择期手术患者应激反应的影响. 护理管理杂志, 15(9), 656-658.]

Mausbach, B. T., Moore, R., Roesch, S., Cardenas, V., & Patterson, T. L. (2010). The relationship between homework compliance and therapy outcomes:An updated meta-analysis. Cognitive Therapy and Research, 34(5), 429-438.

Meize-Grochowski, R., Shuster, G., Boursaw, B., DuVal, M., Murray-Krezan, C., Schrader, R.,... Prasad, A. (2015). Mindfulness meditation in older adults with postherpetic neuralgia:A randomized controlled pilot study. Geriatric Nursing, 36(2), 154-160.

Menezes, C. B., de Paula Couto, M. C., Buratto, L. G., Erthal, F., Pereira, M. G., & Bizarro, L. (2013). The improvement of emotion and attention regulation after a 6-week training of focused meditation:A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2013, 984678.

Menezes, C. B., & Bizarro, L. (2015). Effects of a brief meditation training on negative affect, trait anxiety and concentrated attention. Paidéia (Ribeirão Preto), 25(62), 393-401.

Moulis, G., Sommet, A., Béné, J., Montastruc, F., Sailler, L., Montastruc, J. L., & Lapeyre-Mestre, M. (2012). Cancer risk of anti-TNF-α at recommended doses in adult rheumatoid arthritis:A meta-analysis with intention to treat and per protocol analyses. PLoS One, 7(11):e48991.

Myung, I. J. (2003). Tutorial on maximum likelihood estimation. Journal of Mathematical Psychology, 47(1), 90-100.

Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91-110.

Noggle, J. J., Steiner, N. J., Minami, T., & Khalsa, S. B. S. (2012). Benefits of yoga for psychosocial well-being in a US high school curriculum:A preliminary randomized controlled trial. Journal of Developmental & Behavioral Pediatrics, 33(3), 193-201.

Orme-Johnson, D. W., & Barnes, V. A. (2014). Effects of the transcendental meditation technique on trait anxiety:A meta-analysis of randomized controlled trials. The Journal of Alternative and Complementary Medicine, 20(5), 330-341.

Parsons, C. E., Crane, C., Parsons, L. J., Fjorback, L. O., & Kuyken, W. (2017). Home practice in Mindfulness-Based Cognitive Therapy and Mindfulness-Based Stress Reduction:A systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes. Behaviour Research and Therapy, 95, 29-41.

Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades:An updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43(2), 434-442.

Raghuram, N., Parachuri, V. R., Swarnagowri, M. V., Babu, S., Chaku, R., Kulkarni, R.,... Nagendra, H. R. (2014). Yoga based cardiac rehabilitation after coronary artery bypass surgery:One-year results on LVEF, lipid profile and psychological states-A randomized controlled study. Indian Heart Journal, 66(5), 490-502.

Ratanasiripong, P., Park, J. F., Ratanasiripong, N., & Kathalae, D. (2015). Stress and anxiety management in nursing students:Biofeedback and mindfulness meditation. The Journal of Nursing Education, 54(9), 520-524.

Rothstein, H. R., Sutton, A. J., & Borenstein, M. (2005). Publication bias in meta-analysis:Prevention, assessment and adjustments. Hoboken, NJ:John Wiley & Sons.

Rutledge, T., Mills, P., & Schneider, R. (2014). Meditation intervention reviews. JAMA Internal Medicine, 174(7), 1193.

Schmidt, S. (2011). Mindfulness in east and west-is it the same? In Neuroscience, consciousness and spirituality (pp. 23-38). Netherlands:Springer.

Schmidt, S., Grossman, P., Schwarzer, B., Jena, S., Naumann, J., & Walach, H. (2011). Treating fibromyalgia with mindfulness-based stress reduction:Results from a 3-armed randomized controlled trial. Pain, 152(2), 361-369.

Sedlmeier, P., Eberth, J., Schwarz, M., Zimmermann, D., Haarig, F., Jaeger, S., & Kunze, S. (2012). The psychological effects of meditation:A meta-analysis. Psychological Bulletin, 138(6), 1139-1171.

Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M.,... Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015:Elaboration and explanation. British Medical Journal, 349(7989), g7647.

Shao, X. L., & Jiang, J. H. (2015). Effect of mindfulness-based stress reduction on emotional distress in nasopharyngeal carcinoma patients undergoing radiochemotherapy. Journal of Nursing Science, 30(12), 83-87.

[邵晓丽, 江锦芳. (2015). 正念减压疗法减轻鼻咽癌同步放化疗患者心理痛苦的研究. 护理学杂志, 30(12), 83-87.]

Shen, H. W., Song, Y., Geng, G. L., Yu, J., Xu, X. J., & Ding, M. (2013). Influence of meditation-based interventions on psychological condition of elderly community residents with hypertension. Journal of Nursing Science, 28(7), 67-69.

[沈红五, 宋艳, 耿桂灵, 俞杰, 徐旭娟, 丁敏. (2013). 冥想综合干预对社区老年高血压患者心理状况的影响. 护理学杂志, 28(7), 67-69.]

Shi, Z. Y. (2011). The effect of mindfulness training on college students' anxiety. Science of Social Psychology, 26(2), 83-85, 114.

[石贞艳. (2011). 正念训练对大学生焦虑水平的影响研究. 社会心理科学, 26(2), 83-85, 114.]

Song, Y., Lu, H. X., Chen, H. L., Geng, G. L., & Wang, J. (2014). Mindfulness intervention in the management of chronic pain and psychological comorbidity:A meta-analysis. International Journal of Nursing Sciences, 1(2), 215-223.

Song, Y., Shen, H. W., Kuang, A. N., Yu, J., & Xu, X. J. (2015). Effects of meditation therapy on psychological condition of elderly community residents with hypertention. Chinese Journal of Gerontology, 35(7), 1763-1765.

[宋艳, 沈红五, 匡安娜, 俞杰, 徐旭娟. (2015). 冥想疗法对社区老年高血压患者心理状况的干预效果. 中国老年学杂志, 35(7), 1763-1765.]

Spijkerman, M. P. J., Pots, W. T. M., & Bohlmeijer, E. T. (2016). 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.

Srivastava, M., Talukdar, U., & Lahan, V. (2011). Meditation for the management of adjustment disorder anxiety and depression. Complementary Therapies in Clinical Practice, 17(4), 241-245.

Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-based interventions for people diagnosed with a current episode of an anxiety or depressive disorder:A meta-analysis of randomised controlled trials. PLoS One, 9(4), e96110.

Tang, Y. Y., Yang, L. Z., Leve, L. D., & Harold, G. T. (2012). Improving executive function and its neurobiological mechanisms through a mindfulness-based intervention:Advances within the field of developmental neuroscience. Child Development Perspectives, 6(4), 361-366.

Tekur, P., Nagarathna, R., Chametcha, S., Hankey, A., & Nagendra, H. R. (2012). A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise:An RCT. Complementary Therapies in Medicine, 20(3), 107-118.

Telles, S., Bhardwaj, A. K., Kumar, S., Kumar, N., & Balkrishna, A. (2012). Performance in a substitution task and state anxiety following yoga in army recruits. Psychological Reports, 110(3), 963-976.

Tinsley, H. E., Bowman, S. L., & Ray, S. B. (1988). Manipulation of expectancies about counseling and psychotherapy:Review and analysis of expectancy manipulation strategies and results. Journal of Counseling Psychology, 35(1), 99-108.

van Dam, N. T., Hobkirk, A. L., Sheppard, S. C., Aviles-Andrews, R., & Earleywine, M. (2014). How does mindfulness reduce anxiety, depression, and stress? An exploratory examination of change processes in wait-list controlled mindfulness meditation training. Mindfulness, 5(5), 574-588.

van der Zwan, J. E., de Vente, W., Huizink, A. C., Bögels, S. M., & de Bruin, E. I. (2015). Physical activity, mindfulness meditation, or heart rate variability biofeedback for stress reduction:A randomized controlled trial. Applied Psychophysiology and Biofeedback, 40(4), 257-268.

Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance-and mindfulness-based interventions for the treatment of chronic pain:A meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5-31.

Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness-and acceptance-based interventions for anxiety disorders:A systematic review and meta-analysis. British Journal of Clinical Psychology, 51(3), 239-260.

Wang, F., Pan, Z. F., & Wu, J. N. (2015). The observation to the effect of mindfulness training on patients with panic disorders. Journal of Nursing (China), 22(5), 70-71.

[王芳, 潘志芳, 吴静娜. (2015). 观察正念训练疗法对惊恐障碍患者的干预效果. 护理学报, 22(5), 70-71.]

Wang, G. L., Li, J. M., Zhao, Y. N., Hao, Z. W., & Sun, Z. M. (2014). Observation on rehabilitative efficacy of mindfulness meditation in shoulder hand syndrome after cerebral infarction. Chinese Journal of Coal Industry Medicine, 17(12), 1902-1904.

[王国立, 李建民, 赵雅宁, 郝正玮, 孙竹梅. (2014). 应用正念冥想训练对脑梗死后肩手综合征患者康复效果观察. 中国煤炭工业医学杂志, 17(12), 1902-1904.]

Wang, J. X., Zhao, Y. N., Zhang, P., Liu, Y., Liu, Y., Zhang, Y., & Zhao, Y. (2015). Mindfulness training combined with recreation therapy for life quality among the elderly in nursing home. Chinese Journal of Gerontology, 35(17), 4964-4966.

[王俊霞, 赵雅宁, 张盼, 刘影, 刘洋, 张琰, 赵颖. (2015). 正念训练联合娱乐疗法心理干预对养老院老年人生存质量的影响. 中国老年学杂志, 35(17), 4964-4966.]

Wang, S. X., Wu, J. L., Zheng, R. M., Liu, X. H., Zhong, F. Z., Xu, W., & Shi, Y. (2015). A randomized controlled study of mindfulness training on improving menopausal mood. Chinese Journal of Woman and Child Health Research, 26(2), 225-227.

[王淑霞, 吴久玲, 郑睿敏, 刘兴华, 钟赋真, 徐文, 石英. (2015). 正念训练对更年期妇女情绪影响效果的随机对照研究. 中国妇幼健康研究, 26(2), 225-227.]

Watkins, E. R., Taylor, R. S., Byng, R., Baeyens, C., Read, R., Pearson, K., & Watson, L. (2012). Guided self-help concreteness training as an intervention for major depression in primary care:A phase Ⅱ randomized controlled trial. Psychological Medicine, 42(7), 1359-1371.

Wei, X. H., Liu, Y. M., & Chen, S. X. (2015). A meta-analysis of the relationship between team demographic diversity and team performance. Acta Psychologica Sinica, 47(9), 1172-1187.

[卫旭华, 刘咏梅, 陈思璇. (2015). 团队人口统计特征多元化与绩效关系的元分析. 心理学报, 47(9), 1172-1187.]

Wells, R. E., Burch, R., Paulsen, R. H., Wayne, P. M., Houle, T. T., & Loder, E. (2014). Meditation for migraines:A pilot randomized controlled trial. Headache:The Journal of Head and Face Pain, 54(9), 1484-1495.

Wong, S. Y. S., Chan, F. W. K., Wong, R. L. P., Chu, M. C., Lam, Y. Y. K., Mercer, S. W., & Ma, S. H. (2011). Comparing the effectiveness of mindfulness-based stress reduction and multidisciplinary intervention programs for chronic pain:A randomized comparative trial. The Clinical Journal of Pain, 27(8), 724-734.

Wu, T. T., Luo, Y., Broster, L. S., Gu, R. L., & Luo, Y. J. (2013). The impact of anxiety on social decision-making:Behavioral and electrodermal findings. Social Neuroscience, 8(1), 11-21.

Xu, W., Wang, Y. Z., & Liu, X. H. (2015). Effectiveness of 8-week mindfulness training improving negative emotions. Chinese Mental Health Journal, 29(7), 497-502.

[徐慰, 王玉正, 刘兴华. (2015). 8周正念训练对负性情绪的改善效果. 中国心理卫生杂志, 29(7), 497-502.]

Yang, H. S. (2011). Experimental Study on meditation training for female volleyball players' mood states. Sport, (9), 51-53.

[杨虎生. (2011). 冥想训练条件对女排运动员心境状态影响的实验研究. 运动, (9), 51-53.]

Yuan, S. L., Xie, J. F., Huang, D. H., Zhong, H., Liu, W. L., & Guo, L. R. (2014). Effect of meditation relaxation training combined drug treatment for anxiety disorders patients. Chinese General Practice Nursing, 12(26), 2419-2421.

[袁水莲, 谢建芳, 黄冬华, 钟华, 刘旺林, 郭隆润. (2014). 冥想放松训练联合药物治疗焦虑症的效果. 全科护理, 12(26), 2419-2421.]

Zainal, N. Z., Booth, S., & Huppert, F. A. (2013). The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients:A meta-analysis. Psycho-Oncology, 22(7), 1457-1465.

Zhang, J., Xu, R., Wang, B., & Wang, J. X. (2016). Effects of mindfulness-based therapy for patients with breast cancer:A systematic review and meta-analysis. Complementary Therapies in Medicine, 26, 1-10.

Zhang, M. F., Wen, Y. S., Liu, W. Y., Peng, L. F., Wu, X. D., & Liu, Q. W. (2015). Effectiveness of mindfulness-based therapy for reducing anxiety and depression in patients with cancer:A meta-analysis. Medicine, 94(45), e0897-0.

Zhang, X. (2012). Multiple imputation methods for estimating causal effects in randomized controlled trials with noncompliance and non-response (Unpublished doctorial dissertation). Fudan University, Shanghai.

[张熙. (2012). 多重填补方法估计存在不依从与缺失值的随机对照试验的因果效应 (博士学位论文). 复旦大学, 上海.]

Zhang, Y. (2014). Positive impact of mantra yoga on college students' mental health. Spiritual Leaders, (8), 144-145.

[张洋. (2014). 瑜伽语音冥想对大学生心理健康的积极影响. 赤子(上中旬), (8), 144-145.]

Zhang, Z. (2015). Clinical effect of group psychological intervention on the elderly neurotics. Chinese Journal of Geriatric Care, 13(5), 56-57.

[张卓. (2015). 团体心理干预治疗老年神经症患者的临床疗效. 中国老年保健医学, 13(5), 56-57.]

Zhang, Z. C., Ye, H., Cen, J. N., Zhang, Y. L., & Liu, L. (2015). Effect of mindfulness-based stress reduction on anxiety and depression in cancer patients. Hainan Medical Journal, 26(8), 1150-1152.

[张宗城, 叶桦, 岑建宁, 张艳玲, 刘丽. (2015). 正念减压训练对癌症患者焦虑抑郁情绪的影响. 海南医学, 26(8), 1150-1152.]

Zhong, F. Z., Zhang, Y. P., Wu, J. L., Zheng, R. M., & Liu, X. H. (2015). Evaluation of the effect of comprehensive intervention on menopausal women. Chinese Journal of Woman and Child Health Research, 26(1), 38-41.

[钟赋真, 张运平, 吴久玲, 郑睿敏, 刘兴华. (2015). 更年期妇女正念心理干预措施效果评价研究. 中国妇幼健康研究, 26(1), 38-41.]

Zoogman, S., Goldberg, S. B., Hoyt, W. T., & Miller, L. (2015). Mindfulness interventions with youth:A meta-analysis. Mindfulness, 6(2), 290-302.