: ~..
Regular Article
John A. Astin
Department ofPsychology and Social
Behavior, University ofCalifomia.,
Irvine, Calif., USA
KeyWords
Mindfulness meditation
Psychotherapy
Randomized controlled study
Depression
Anxiety
Psychological stress
Life events
Somatization
Psychother Psychosom 1997;66:97-106
Stress Reduction through
MindfulnessMeditation
Effects on Psychological Symptomatology, Sense of Control, and
Spiritual Experiences
..................................................................................................
Abstract
Background: This study examined the effects of an 8-week stress reduction
program based on training in mindfulness meditation. Previous research
efforts suggesting this program may be beneficial in terms of reducing stress-
related symptomatology and helping patients cope with chronic pain have
been limited by a lack of adequate comparison control groups. Methods:
Twenty-eight individuals who volunteered to participate in the present study
were randomized into either an experimental group or a nonintervention con-
trol group. Results: Following participation, experimental subjects, when
compared with controls, evidenced significantly greater changes in terms of:
(1) reductions in overall psychological symptomatology; (2) increases in over-
all domain-specific sense ofcontrol and utilization of an accepting or yielding
mode of control in their lives, and (3) higher scores on a measure of spiritual
experiences. Conclusions: The techniques of mindfulness meditation, with
their emphasis on developing detached observation and awareness of the con-
tents of consciousness, may represent a powerful cognitive behavioral.coping
strategy for transforming the ways in which we respond to life events. They
may also have potential for relapse prevention in affective disorders.
Introduction
It has been estimated that 50% of all medical patients
seen in general practice are suffering from stress-related
problems [1]. The Public Health Service's 1979 report
entitled 'Healthy People' [2] similarly concluded that
excessive stress was a serious public health concern for
Americans. Research suggests that stress may exacerbate
or be a significant etiological factor in hypertension [3, 4],
heart disease [5], alcohol/drug abuse [6, 7], anxiety [8],
depression [9], and gastrointestinal disorders [10]. These
conditions may be symptomatic of excessive psycho--
physiological stress or represent maladaptive attempts to
cope with the challenges and stresses of life [11].
Correspondingly, when one considers the tremendous
cost of treating these conditions (e.g., with anxiolytics,
antidepressants, dnlg and alcohol rehabilitation pro-
grams, psychotherapy, over-the-counter products for gas-
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John A. Astin
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I trointestinal di~turbances, antihypertensivemedications),
stress reduction/management techniques emerge not only
as potentially important preventive medicine tools but
also as invaluable aids in reducing our nation's enormous
health care bill. It has been estimated, for example, that in
the United States stress-related disorders account for as
much as US$ 17 billion a year in lost productivity at the
workplace [12].
The potential health and economic benefits of stress
reduction programs are in fact now being realized by sev-
eral large insurance companies that have begun offering
reimbursement for two notable .programs, Dr. Deane Or-
nish's [13] 'Program for .Reversing Heart Disease' and
'The Stress Reduction and Relaxation Program' devel-
oped by Jon Kabat-Zinn [14] at the University ofMassa-
chusetts [15, 16]. It is important that further clinical
research be conducted in order to test the relative effec-
tiveness of these and other stress reduction programs. The
degree to which such programs are perceived as effective
and legitimate health care strategies in the eyes of practi-
tioners, insurers and the general public will depend, in
part, on whether with well-controlled outcome studies
these initially promising findings concerning their effica-
cy can be replicated.
The present study represents such an attempt. It was
designed to further test the potential health benefits ofan
8-week program in stress management modeled very
closely after Kabat-Zinn's [14] Stress Reduction and Re-
laxation Program (SRRP). Despite the serious method-
ologicallimitations of using self-selected samples and not
having adequate comparison or control groups, previous
findings suggest this 8-week intervention may be effective
both in terms of reducing overall psychological symptom-
atology, and helping individuals suffering from various
forms of chronic pain to cope more effectively with its
disabling psychological and physical effects [14, 17, 19].
Research by Kabat-Zinn et a1. [18] also suggests that this
program may be clinically useful for patients suffering
from anxiety disorders with the majority of patients still
maintaining positive changes at a 3-year follow-up.
Kutz et a1. [20] also examined the effects of a stress
reduction program modeled specifically after Kabat-
Zinn's as an adjunct to psychotherapy. Their study ex-
plored the clinical usefulness of training in mindfulness
meditation techniques in 20 patients undergoing long-
term psychotherapy (presenting problems ranging from
severe personality disorders to anxiety and obsessive neu-
roses, with psychotic patients being excluded). Significant
decreases in psychological symptomatology were ob-
served both after intervention and at 6-month follow-up.
The reductions inSCL-90-R scores were similar to those
observed in a recent study examining the effects of short-
term psychotherapy (lasting approximately 40 weeks) for
personality disorders [21].
The changes in symptomatology scores observed by
Kutz et a1. [20] were also consistent with therapists' clini-
cal ratings,.both after intervention and at follow-up. They
rated a majority of these subjects as showing moderate to
great improvement in a number ofareas including overall
intensity of current problems, overall psychic distress,
anxiety, depression, self-assertion and insight. However,
as with the previously cited research examining the clini-
cal usefulness of this meditation-based stress program
[14, 17, 19], there were serious methodological limita-
tions, principally the absence of any type of comparison
group. As a result, it is unclear whether the observed
changes in sympt"matology were the result of subjects'
involvement in the meditation intervention, their partici-
pation in individual psychotherapy, or some combination
ofor interaction between the two.
In tenns ofreductions in symptomatology as measured
by the SCL-90-R, Kabat-Zinn [14] observed mean de-
creases in General Severity Index (GSI) scores of34-38%.
These findings are comparable to other research on both
meditation and a variety of biobehavioral techniques
[22-26]. However, despite the encouraging findings on
the SRRP cited above, both Kabat-Zinn et al. [17] and
Kutz et al. [20] point out that further research is needed to
test the effectiveness of this meditation-based interven-
tion using better controlled, experimental designs. In an
effort to control for the confounding factors of history,
maturation, and testing outlined byCampbell and Stanley
[27], the present study used an experimental design in
which subjects were randomized into either the 8-week
stress program or a nonintervention, waiting-list control
group. The present study also attempted to test whether
the previously reported positive changes resulting from
this program might also be obtained from a nonclinical
population.
Along with testing, in a more controlled setting, the
effectiveness of this intervention in reducing psychologi-
cal symptomatology, the present study also examined this
program's impact on subjects' sense of control using the
Shapiro Control Inventory (SCI) [28] as well as spiritual
experiences using the Index ofCore Spiritual Experiences
(INSPIRIT) [29].
Sense ofControl
Research suggests that having a sense of control over
one's cognitive, affective and behavioral experiences is
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98 Psychother Psychosom 1997;66:97-106 Astin