We found that U.S. adults with various pain syndromes, anxiety/depression, and insomnia were more likely to use alternative mind-body therapies compared to adults without these conditions. Among adults using MBT to treat specific medical conditions, MBT was most commonly used to treat anxiety/depression and musculoskeletal pain syndromes. More than 50% of these respondents reported MBT use in conjunction with conventional medical care, 30% used MBT because a conventional medical professional recommended it, and 20% used because they thought conventional medicine would not help. Overall, we found high rates (68-90%) of perceived helpfulness of MBT in treating specific medical conditions.
Our results are consistent with previous research of MBT use in nationally representative samples, with similar rates of use of MBT overall (18.9%), meditation (7.0%), and yoga (3.7%);2, 12
however, we found different prevalences of use for other individual MBT therapies.2, 12
Our results suggest that the rate of use of relaxation techniques of 14.2% is substantially higher than the 5.0% previously reported from the 1999 NHIS.2, 16
Additionally, we found much lower use of MBT for treatment of specific medical conditions compared to previously published data.12
For example, Wolsko et. al. estimated 11.2 million adults had used MBT for treatment of back pain,12
yet we found that fewer than 1.5 million adults with back pain used MBT for this condition. These differences may reflect the change in patterns of use over time, but may also reflect different survey instruments.
Despite the popularity of MBT use, research on its therapeutic benefits is in its infancy. While studies examining the benefit of MBT for treatment of specific medical conditions have increased in number, methodological issues, such as small sample sizes and inadequate control groups17
have limited the interpretation and generalizability of the data. For example, a recent Cochrane review evaluating the literature on meditation for anxiety concluded that “the small number of studies [of high enough quality to be] included in this review do not permit any conclusions to be drawn on the effectiveness of meditation therapy for anxiety disorders” and “more trials are needed.”18
Thus available data on the efficacy of MBT are suggestive at best, and no firm conclusions can be drawn at this time, thereby limiting recommendations for widespread adoption and use for treatment of specific conditions.
One example of how these methodological issues curb our ability to routinely recommend MBT can be found in the literature examining Mindfulness Based Stress Reduction (MBSR) for treatment of anxiety and depression. MBSR is a formal program that cultivates mindfulness, defined as non-judgmental moment-to-moment awareness, through meditation, body scan (sequential attention to parts of the body while supine), and mindful movement (body awareness during yoga postures).19
Though results from recent clinical studies have been promising,20-23
most studies have used a wait-list or treatment as usual control group, which makes it difficult to distinguish the true effects of MBSR from group effects or placebo responses. A recent review of MBSR for anxiety and mood symptoms in clinical populations24
reported a statistically significant reduction in anxiety or depression after MBSR in eight of fifteen clinical studies reviewed.20, 21, 25-31
However, none of the positive studies had an active control.24
By utilizing control groups that are commensurate with MBSR in subject contact time and attention, as well as in physical activity level, we could better discern the specific effects of mindfulness training. Furthermore, using objective measures of mindfulness would provide support that changes in outcomes are in fact mediated by cognitive shifts. Moreover, the totality of data on meditative techniques for the treatment of anxiety and depression have limited applicability in clinical populations, as several studies evaluated healthy populations, focused on situational anxiety (such as music performance), and lacked clear standardized diagnostic criteria for anxiety and/or depression.18, 24
Despite the limitations of the current literature, we found that more than two-thirds of adults who use MBT to a specific condition found MBT helpful. Reasons for the perceived beneficial effects of MBT for these conditions are unclear, and may include physiological and psychological effects, or even placebo responses32
It should be noted high rates of perceived helpfulness do not signify medical efficacy. Given the high prevalence of MBT use and the suggestive preliminary data, definitive randomized controlled trials, which are sufficiently large and of high quality, are needed to examine both the potential therapeutic benefits and mechanisms , as well as the potential side effects and risks of individual MBT therapies.
One surprising finding was that 30% of adults using MBT to treat a condition reported a conventional provider recommended it, even though there is not clear evidence to support its use. Limited research suggests that the factors influencing physicians’ recommendations of CAM include lack of response to conventional therapies, patient preferences, physician knowledge of and belief in the efficacy of CAM, and few adverse events with CAM.33, 34
Researchers have theorized that trends in physicians’ attitudes and beliefs toward CAM are likely to vary regionally,34
by provider environmental influences, and by cultural norms.35
As data on MBT become available, it will be important to understand how physicians’ knowledge, attitudes, and beliefs of MBT affect decision-making processes, as they may serve as important advocates for or as potential barriers to the adoption of evidence-based integrative care.
With nearly 20% of U.S. adults using MBT, little is known about which additional factors are driving the high rates of use of these “alternative” therapies, as the vast majority are not using MBT to treat a specific condition. Astin et al. found that adults used CAM “largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life”.36
However the reasons for CAM use, including MBT, remain poorly understood. We found among respondents using MBT for treatment of a specific medical condition that more than 50% used MBT because they thought that it was interesting to try; 50% also thought that MBT use combined with conventional therapy would be beneficial. Identification of additional factors influencing use of MBT would further our understanding of patient needs and expectations, and expand our current biopsychosocial model of health care.
Furthermore, given the common use of MBT, it would be important to note potential adverse effects of MBT practice, particularly in patients with medical and psychological conditions. For instance, the association between yoga and several musculoskeletal conditions may be indicative of injuries induced by yoga.37
In addition, with 20% of MBT users reporting they use MBT since they believed conventional medicine would not help, we may speculate that a segment of the clinical population may be using MBT alternatively, rather than complementary to conventional medicine. This theoretically may limit access to appropriate conventional care. Further research on MBT for treatment of chronic conditions would also provide important data on the risks of MBT use in specific clinical populations.
Our study has limitations. The self-reporting nature of the NHIS may lead to misclassification and recall bias. Furthermore, MBT is difficult to define, particularly given the overlap with behavioral therapy and spirituality, and therefore we may not have accurately captured the true prevalence of use. Likewise, respondents were limited to MBT specifically queried by NHIS and NHIS categorizations, such as deep breathing exercises, may not be considered as MBT by some respondents,further impacting our ability to accurately estimate the prevalence of use. NHIS also did not assess quantity or duration of MBT use, which limits our ability to distinguish the characteristics of onetime users compared with adults practicing MBT over time. In addition, the 2002 NHIS was administered only in English and Spanish, and certain immigrant populations that are less acculturated may have different patterns of MBT use38
that were not captured. Lastly, NHIS does not collect data on all possible reasons for MBT use, such as for peri-procedural pain control.33, 39