Review articleDo workplace-based mindfulness meditation programs improve physiological indices of stress? A systematic review and meta-analysis
Introduction
Workplace stress is associated with costs to individuals, organizations, and the community. It is consistently linked with poorer health outcomes, including cardiovascular disease [1,2], psychosomatic problems, musculoskeletal disorders [3] and self-reported health [4,5]. Workplace stress is also associated with mental health issues, including depression and anxiety disorders [6,7]. Finally, it is also related to a number of pre-clinical markers of ill-health, including indicators of the immune system [8], cardiovascular health [9] and the hypothalamic-pituitary-adrenal (HPA) axis [10,11]. In addition to health concerns, the cost of workplace stress extends to the employer due to higher turnover rates [12,13], increased absences [14] and decreased work engagement [15]. Given the associated costs of workplace stress to individuals and society it is important to determine the most appropriate interventions to reduce it.
Interventions that are suitable to the workplace environment are rare [16], but a contemporary intervention with promising results across different populations and settings, including the workplace, is mindfulness meditation [17,18]. This is the act of purposefully paying attention to the present moment and being aware of mental states and processes with a sense of openheartedness, curiosity and kindness, and without judgement [19].
An increasing body of evidence demonstrates the effectiveness of mindfulness-based interventions (MBI) in improving job satisfaction, wellbeing, health, and reducing workplace stress [[20], [21], [22]]. However, a synthesis of the effects of MBIs on physiological indicators of workplace stress and ill-health is lacking.
Recent reviews conclude that MBIs improve dysregulated cortisol responses and immune functioning [[23], [24], [25]]; however, these reviews investigated patient populations and healthy adults, rather than MBIs in workplace settings. Previous research has shown different forms of chronic stress (e.g. work stress, caregiving, death/loss) have disparate effects on physiological outcomes [26,27]. Moreover, the few reviews that have considered employees and include physiological indicators, consider indices of multiple biological systems (e.g., the immune system, hypothalamic–pituitary–adrenal axis) together [20,28]. This coarse, unidimensional approach may contribute to the mixed findings of the effects of MBIs on physiological outcomes [20]. In the present review, we will synthesise the effects of MBI on discrete biological systems.
Inclusion of physiological indices are important to consider as they may act as pre-clinical markers of the development of ill-health [29]. When a stressor is experienced biological systems are activated to prepare the body to overcome the stressor. For example, the hormone cortisol, a primary product of the HPA axis, is associated with cardiovascular mortality and depression [[30], [31], [32]]. Likewise, C-reactive protein (CRP) and interleukin 6 (IL-6), two biomarkers of systemic inflammation are predictors of depression [33]. Increased CRP levels are also associated with increased risk of myocardial infarction [34]. Lower heart-rate variability (HRV), an indicator of cardiovascular function, is linked to all-cause mortality and cardiovascular disease [35]. By considering physiological indicators of stress we can gain a greater understanding of the potential mechanisms of action of MBI on these biological systems.
A relevant model that can explain how MBIs modify dysregulated physiological responding is the integrated specificity model. The central tenant of the model is that the cognitive appraisal of a stressor is associated with distinct emotions, which in turn results in a specific, integrated pattern of physiological responses [36]. For example, threat emotions have been found to explain 56% of the variance in cardiovascular reactivity to an acute stressor [37], while social evaluative threat has also been associated with increased cortisol and pro-inflammatory responses [38]. Mindfulness may be a particularly effective resource as it increases an individual's ability to experience stressors without automatically perceiving them as a threat [39]. Indeed, higher levels of dispositional mindfulness have been found to moderate the effects of a social evaluative stressor on negative affect and cortisol responses [40]. The positive relationships observed between dispositional mindfulness and health [[20], [21], [22]] may be due to the MBIs reducing the experience of threat or harm emotions and the subsequent adverse physiological reactions these emotions provoke. However, as physiological indicators of stress have been included as outcomes in several recent studies, the first step to understanding these posited relationships is to synthesise this literature to assess the efficacy of MBI's in promoting adaptive physiological responses.
Given the increasing popularity and the potential for MBIs to be an effective and easily-implemented intervention for the workplace, it seems timely to provide a review of the literature investigating MBIs and physiological indicators of stress and ill-health. Previous reviews and meta-analyses have recommended the use of objective measures in future studies [18,21]; an aim of the present review is to synthesise the literature from employee samples to provide guidance for future investigations in terms of which physiological indicators and biological systems may be most impacted by MBIs.
Section snippets
Method
The current systematic review and meta-analysis followed the PRISMA guidelines for systematic reviews and meta-analyses [41]. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), under registration number CRD42016052826.
Study characteristic
Nine papers published between 2003 and 2015 investigated the effects of a mindfulness intervention on pre-clinical markers of ill-health. The characteristics of the included studies are presented in Table 1. Of the ten individual studies included in the nine papers, there were a total of 26 comparisons. Total sample size was 812 after attrition, 86 participants dropped out across the studies. Individual studies ranged from 18 to 239 participants (M = 81.20, SD = 74.65). There were 409
HPA axis measures
One study used a within group comparison of the mindfulness intervention while four other investigations utilised mixed within-between designs that incorporated a control group. The four studies that compared the effects of mindfulness training against a control group across time on HPA axis indices (i.e., CAR, 0 and 30 min post waking, high and low diurnal cortisol slopes, average diurnal cortisol concentration, pre-lunch and bedtime cortisol) reported inconsistent findings. We conducted a
Discussion
The current systematic review and meta-analysis aimed to provide a synthesis of the literature of the effectiveness of MBIs in improving physiological indices of stress in employee populations. The findings indicate that MBIs were effective in increasing high and low diurnal cortisol slopes, which is suggestive of a better regulated HPA axis. The findings regarding cardiovascular indicators were mixed, with MBIs improving autonomic balance as assessed by the HRV coherence ratio measure but
Conclusion
Considered together, the studies reviewed suggest that MBIs are a promising avenue for encouraging adaptive physiological responses. In particular, the diurnal cortisol slopes, HRV coherence, SNS activity and some indicators of immunity differed pre-post intervention. Our review indicates that mindfulness may act on discrete physiological systems differently with the preliminary evidence suggesting that the HPA axis in particular, is more consistently influenced than the cardiovascular, and SNS
Conflict of interest
The authors declare that they have no conflict of interest.
References (71)
- et al.
Job strain as a risk factor for coronary heart disease: a collaborative meta-analysis of individual participant data
Lancet
(2012) - et al.
Effort-reward imbalance model and self-reported health: Cross-sectional and prospective findings from the GAZEL cohort
Soc. Sci. Med.
(2004) - et al.
Associations between the effort-reward imbalance model of workplace stress and indices of cardiovascular health: a systematic review and meta-analysis
Neurosci. Biobehav. Rev.
(2017) - et al.
Effort reward imbalance, and salivary cortisol in the morning
Biol. Psychol.
(2012) - et al.
Job demand and job resources as predictors of absence duration and frequency
J. Vocat. Behav.
(2003) - et al.
Mindfulness-based stress reduction and health benefits: a meta-analysis
J. Psychosom. Res.
(2004) - et al.
Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR)
Complement. Ther. Clin. Pract.
(2009) Stress hormones in health and illness: the roles of work and gender
Psychoneuroendocrinology
(2005)- et al.
Diurnal cortisol slopes and mental and physical health outcomes: a systematic review and meta-analysis
Psychoneuroendocrinology
(2017) - et al.
The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors
Int. J. Cardiol.
(2010)
Trait mindfulness modulates neuroendocrine and affective responses to social evaluative threat
Psychoneuroendocrinology
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control. Clin. Trials
An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results
Gen. Hosp. Psychiatry
Workplace based mindfulness practice and inflammation: a randomized trial
Brain Behav. Immun.
Salivary cortisol profiles in patients remitted from recurrent depression: One-year follow-up of a mindfulness-based cognitive therapy trial
J. Psychiatr. Res.
Mindfulness and heart rate variability in individuals with high and low generalized anxiety symptoms
Behav. Res. Ther.
Assessment of the cortisol awakening response: Expert consensus guidelines
Psychoneuroendocrinology
Free cortisol awakening responses are influenced by awakening time
Psychoneuroendocrinology
Work-related psychosocial factors and the development of Ischemic Heart Disease
Cardiol. Rev.
The relationship between job satisfaction and health: a meta-analysis
Occup. Environ. Med.
Does job burnout mediate negative effects of job demands on mental and physical health in a group of teachers? Testing the energetic process of job demands-resources model
Int. J. Occup. Med. Environ. Health
Two models of job stress and depressive symptoms
Soc. Psychiatry Psychiatr. Epidemiol.
Psychosocial work environment and mental health- a meta-analytic review
Scand. J. Work Environ. Health
A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress with indicators of immune function
J. Psychosom. Res.
A systematic review and meta-analysis of the effort-reward imbalance model of workplace stress and hypothalamic-pituitary-adrenal axis measures of stress
Psychosom. Med.
The impact of work stress and job satisfaction on turnover intentions: a study of Australian specialist alcohol and other drug workers
Drugs Educ. Prev. Policy.
The impact of stress and support on direct care workers' job satisfaction
Gerontologist
Burnout and work engagement: the JD–R approach
Annu. Rev. Organ. Psych. Organ. Behav.
Effects of occupational stress management intervention programs: a meta-analysis
J. Occup. Health Psychol.
Mindfulness-based interventions reduce psychological distress in working adults: a meta-analysis of intervention studies
Mindfulness
Mindfulness-based interventions in context: past, present, and future
Clin. Psychol. Sci. Pract.
What do we really know about the effects of mindfulness-based training in the workplace?
Ind. Organ. Psychol.
The impact of mindfulness on well-being and performance in the workplace: an inclusive systematic review of the empirical literature
Eur. J. Work Organ. Psychol.
Mindfulness meditation and the immune system: a systematic review of randomized controlled trials
Ann. N. Y. Acad. Sci.
A systematic review of the effects of mindfulness interventions on cortisol
J. Health Psychol.
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2022, Journal of Substance Abuse TreatmentCitation Excerpt :One alternative way to alleviate stress is through mindfulness training, which is an inexpensive cognitive behavioral treatment that employs mindfulness to psychoeducate and alleviate suffering (Grossman et al., 2004; Witkiewitz et al., 2005). Recent research indicates that workplace-based mindfulness programs improve physiological indices of stress, well-being, and job satisfaction and are an effective way of reducing stress (Aikens et al., 2014; Bartlett et al., 2019; Heckenberg et al., 2018). Previous research among shift workers has highlighted that breaks are a necessary strategy for coping with stress, alongside the ability to have some control over schedules, which allows for more efficient personal time management (Pisarski et al., 1998; Savic et al., 2019).
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