24 November 2020

Mindfulness and meditation as a cancer therapy - the research evidence summarised

In 1967, Dr Ainslie Meares published a ground breaking book – Relief Without Drugs in which he advocated meditation as a therapy for a wide range of physical and psychological conditions.

In 1985, Dr Meares published an hypothesis in the Medical Journal of Australia in which he speculated intense meditation might actually reverse the progress of cancer. At the time, I had been diagnosed with advanced secondary osteo-genic sarcoma (bone cancer) and had a prognosis of 3 to 6 months. 

Having agreed to test Dr Meares hypothesis and used his methods as a core element in my subsequent survival, and having taught those techniques (along with additions) to many thousands of people affected by cancer over 4 decades, I have lived long enough to see the place of meditation in cancer management go through the 19th century German philosopher Schopenhauer’s 3 stages of truth : First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident. Well, almost. 

It seems reasonable to contend meditation has entered the mainstream in a general sense. It enjoys widespread acceptance and uptake. It is estimated that 200–500 million people meditate worldwide.

When it comes to cancer, the evidence regarding its contribution to improving quality of life for both patients, survivors and carers is compelling. Search scholarly articles for mindfulness and meditation and cancer, and around 1.5 million results appear. However, regarding the capacity to actually increase survival, while case reports and some small studies are positive, this is an area of little good quality research.  

So what follows is a summary of key research articles validating the benefits of mindfulness, meditation and related practices for people affected by cancer. This is no PhD article and makes no claim to be comprehensive, but hopefully it does highlight some of the best of recent research in the field. So here is a photo of the remarkable Dr Meares and a long list of research, but first


       Thought for the day

    In human intercourse the tragedy begins

    Not when there is misunderstanding about words,

    But when silence is not understood.

                            Henry David Thoreau


Short on time? Need the most important and latest findings? 

Here they are, while much more detail follows…


The evidence strongly suggests meditation and mindfulness-based programs do improve quality of life – in person and online. Two recent meta-analyses of mindfulness programs for cancer patients and survivors have both reported improvements in pain, psychological distress, anxiety, depression, fear of cancer recurrence, and sleep quality. Of note, four of the 29 studies included were online programs where the online programs recorded similar benefits to face-to-face programs.

i) This 2020 review of 28 RCTs enrolling 3053 adults with cancer was published in the prestigious Journal of the American Medical Association. The findings? Mindfulness Based Interventions (MBIs) were associated with significant reductions in the severity of short-term and medium-term anxiety but not long-term. MBIs were associated with a reduction in the severity of depression in the short term and the medium term; as well as improved health-related quality of life in patients in the short term and the medium term. The study also found MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer. 

Oberoi S, et al. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Aug 3;3(8):e2012598. doi: 10.1001/jamanetworkopen.2020.12598. 

ii) This 2019 review of 29 independent RCTs with 3274 participants found small and statistically significant effects of MBIs on combined measures of psychological distress. Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.

Cillessen, L et al. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology, 28(12), 2257–2269


Perhaps surprisingly, the volume of research directly investigating the role meditation and mindfulness might play in improving survival rates is way less than that examining quality of life benefits. However, some studies do show that improvements in quality of life are associated with life extension; perhaps most notably when depression is treated survival rates extend significantly.

One good direct example of possibilities is provided by the work of Prof Dean Ornish. For over a decade he has studied prostate cancer and the effects of lifestyle interventions on the progression of the disease. These long-term studies have consistently shown intensive lifestyle changes that include the regular practice of meditation decrease Prostate Specific Antigen (PSA) readings, increase telomere length, and slow the progression of prostate cancer.

Telomeres can be compared to small protective caps of DNA and protein at the end of each chromosome. The shortening of telomeres has been associated with a broad range of disease, including cancer, stroke, obesity, vascular dementia and cardiovascular disease. Research indicates that longer telomeres are associated with fewer illnesses and longer life.

After one year in this randomised study of 92 men, PSA levels had decreased by 4% in the lifestyle group and increased by 6% in the control group. After two years, 27% of patients in the control group had required treatment for cancer progression, but only 5% of the lifestyle group needed other treatment. It seems that the programme not only down-regulated gene expression for prostate cancer, it increased telomerase activity (telomerase being enzyme that lengthens and repairs telomeres). 

Follow up after five years showed a significant increase in telomere length in participants who had adhered to the meditation and lifestyle changes. The control group underwent active surveillance only, and showed a notable decrease in telomere length.

Ornish commented in 2013 “larger randomised controlled trials are warranted to confirm this finding.”  Remarkably, as yet, to my knowledge no further studies testing the impact of meditation and lifestyle interventions on cancer reversal have been reported.

Ornish D. Weidner G. Fair WR. et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005;174(3):1065-9.
Ornish et al. Journal of Urology 2005;174:1065-70.
Ornish D, Blackburn EH et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. Lancet Oncol. 2013 Sep 16. 




Earlier research into the general benefits of mindfulness, meditation and related practices indicated a range of physiological and psychological benefits, many of which have direct implications for cancer. As a result of this early research and independent of potential effects on survival, at the start of this century mindfulness and meditation became increasingly accepted as an evidence-based option to be offered to patients to improve their coping with cancer, to assist with symptom control and to foster a better quality of life.

A brief summary of these related benefits include 

i) Improved sleep

Sephton S. Spiegel D. Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to 
disease? Brain Behav Immun. 2003;17(5):321-8. 

ii) Elevation of melatonin levels

Mahmoud F. Sarhill N. Mazurczak MA. The therapeutic application of melatonin in supportive care and 
palliative medicine. Am J Hospice & Palliative Care. 2005;22(4):295-309.  

iii) Improved pain control

Kabat-Zinn J et al. J Behav Med. 1985;8(2):163-90.

iv) Improvement of depression

Teasdale JD, Moore RG, Hayhurst H, et al. J Consult Clin Psychol. 2002;70(2):275-87.

v) Less anxiety, better coping

Tacon AM. Et al. Family & Comm Health. 2003;26(1):25-33. 

Speca M, et al. Psychosom Med. 2000;62(5):613-22 

vi) Improved immunity

Davidson RJ Psychosom Med. 2003;65(4):564-70. 

vii) Spiritual factors

A review of 71 research articles indicated that imagery, meditation and group support activities may address spiritual health, resulting in beneficial outcomes of enhanced physical and emotional health and decreased cancer mortality.

Hawka SR et al. Am J Health Promot. 1995 May-Jun;9(5):371-8 

viii) Telomere length and survival

The following 3 studies reported on the association between meditation, telomerase activity and increased telomere length (there is no drug known currently that can accomplish this).

Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008; 9: 1048‐ 1057.

Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011; 36: 664‐ 681.

Quinn A. et al, Insight meditation and telomere biology: The effects of intensive retreat and the moderating role of personality, Brain, Behavior, and Immunity, Volume 70, 2018, Pages 233-245,


More recently, so much specific cancer-related research has been published investigating the role of mindfulness, meditation and related practices in cancer management, that meta-analysis are now common. Here are some of the more recent ones.

i) Clinical Practice Guidelines

These guidelines are provided to inform clinicians and patients about safe and effective evidence-based therapies as supportive care in patients treated for breast cancer by the American Society for Integrative Oncology Guidelines Working Group. They were developed using the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. The search identified 4900 articles, of which 203 were eligible for analysis. 

Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Meditation, stress management, yoga, massage, music therapy and energy conservation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). 

Greenlee, Heather et al. “Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer.” Journal of the National Cancer Institute. Monographs vol. 2014,50 (2014): 346-58. doi:10.1093/jncimonographs/lgu041

ii) Cancer related pain and meditation-based techniques 

A systematic review in 2019 of 6 studies that met strict criteria was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL. 

Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia Pac J Oncol Nurs. 2019;6(2):161-169. 

 iii) Mindfulness and breast cancer specifically

This 2019 meta-analysis investigated 14 studies involving 1505 participants. It found statistically significant benefits for physiological function, cognitive function, fatigue, emotional wellbeing, anxiety, depression, stress, distress and mindfulness. Although the effects on pain, sleep quality, and global QoL were in the expected direction, they were not statistically significant based on insufficient evidence. The authors concluded the mindfulness-based program MBSR is worthy of being recommended to breast cancer patients as a complementary treatment or adjunctive therapy.

Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients-a systematic review and meta-analysis. Zhang Q, Zhao H, Zheng Y Support Care Cancer. 2019 Mar; 27(3):771-781.


i)  Depression and its impact on mortality

Depression affects many people diagnosed with cancer and left untreated it is associated with increased mortality. This study investigated 1790 patients within 3 months of lung cancer diagnosis. 38% had depression at baseline and an additional 14% developed new-onset depression during cancer treatment. Depression symptoms at baseline were significantly associated with a 17% higher risk of mortality and was most marked in young patients.

At 12 months of follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease and those with late-stage disease. 

Importantly, remission of depression symptoms is associated with a similar mortality rate as never having had depression.

Sullivan DR, Forsberg CW, Ganzini L, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol. 2016 Oct 3. doi: 10.1200/JCO.2016.66.8459.

ii) Strong depression link with breast cancer mortality

This randomized trial on 125 women with metastatic breast cancer compared a treatment group to a control group that received educational materials. Median survival time was 53.6 months for women with decreasing depression scores over 1 year and 25.1 months for women with increasing CES-D scores. Neither demographic nor medical variables explained this association. The researchers commented :

“Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with breast cancer in this sample.”

Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in Depression Symptoms Is Associated With Longer Survival in Patients With Metastatic Breast Cancer: A Secondary Analysis. J Clin Oncol. 2011 February 1; 29(4): 413–420.

iii) Cortisol levels

This study demonstrated mindfulness and meditation can reduce cortisol levels in cancer patients – high cortisol levels being a sign of a poor prognosis – and improve quality of life.

Carlson LE. Speca M. Patel KD. Goodey E. Psychoneuroendocrinology. 2004;29(4):448-74.

iv) Mindfulness in a group setting

This trial compared 2 empirically supported psychosocial group interventions, mindfulness‐based cancer recovery (MBCR) and supportive‐expressive group therapy (SET), with a minimal‐intervention control condition on mood, stress symptoms, quality of life, social support, and diurnal salivary cortisol in distressed breast cancer survivors. The mindfulness-based group resulted in the most psychosocial benefit, including improvements across a range of psychosocial outcomes. Both MBCR and SET resulted in healthier cortisol profiles over time compared with the control condition.

Carlson LE, Doll R, Stephen J, et al. Randomized controlled trial of mindfulness‐based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013; 31: 3119‐ 3126.

v) Short term intervention effective

Each patient in this study received an individual meditation consultation (60-minute initial visit and 30 minute follow-up visits). Participants recorded significant reductions from pre- to post- meditation session in physical, psychological and symptom distress component scores. All changes reached statistically and clinically significant thresholds. Researchers concluded that “a single meditation session resulted in acute relief in multiple self-reported symptoms with the greatest reduction in anxiety, fatigue & distress.”

Chaoul, A., et al. (2014). An Analysis of Meditation Consultations in an Integrative Oncology Outpatient Clinic. The Journal of Alternative and Complementary Medicine, 20(5), A86-A86.

vi) Mental state and vigour

Where cancer patients learn mindfulness in their cancer management they were found to have significantly lower scores for low mood, depression, anxiety, anger, and confusion but they also had more vigour.  They also had fewer overall physical and stress symptoms. 

Speca M, et al. Psychosom Med. 2000;62(5):613-22

vii) Mindfulness and immunity

Among cancer patients, the significant improvements seen in overall quality of life, symptoms of stress, and sleep quality are associated with improvements in immunity with lower levels of the inflammatory hormones that can accelerate cancer growth.

Carlson LE. Speca M. Patel KD. Goodey E. Psychosomatic Medicine. 2003;65(4):571-81.

People also show better immune response to vaccinations and increases in antibodies.

Davidson RJ Psychosom Med. 2003;65(4):564-70.  

viii) Meditation improves quality of life for breast cancer survivors

This study reported meditation was associated with significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep.

Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.

Yun MR et al : The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct;40(5):377-385.

ONLINE PROGRAMS – increasingly well proven

i) Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

ii) How do online programs compare to face to face? 

Mindfulness-based interventions are shown to be effective in reducing psychological distress in people affected by cancer. However, these interventions lack availability and flexibility, which may compromise participation in the intervention, especially for people experiencing symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. Here are 5 research reports demonstrating online programs have similar outcomes to in person programs…

This first study examined a randomised group of 245 heterogeneous patients with cancer affected by psychological distress. Compared with Treatment as Usual (TAU), MBCT and eMBCT were similarly effective in reducing that psychological distress. Also, both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU. 

Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.

This second study provides further evidence for the feasibility and efficacy of an online adaptation of a mindfulness-based program as it reported usage was associated with the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual waitlist. 

Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.

This third study found nonusers had more fear of cancer recurrence at baseline than users. Regular users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. The study showed that adherence was related to improved patient outcomes. The researchers recommended patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.

Cillesen L; et al. Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study; J Med Internet Res 2020;22(10):e17526)

Fourthly, this trial compared an online 6 week program to Treatment As Usual. It concluded online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioural manifestations in cancer survivors, especially those who are unable to participate in in-person training. Effect sizes were all medium to large as well.

Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10:2143–2151. 

Finally, this study focused on the long-term effects of a RCT during the nine-month follow-up period. The study compared a mindfulness-based program delivered online with the same program delivered in person. Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life in both interventions over the course of the nine-month follow-up. Furthermore, patients seemed to benefit more from the online program based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness.

Cillessen L, et al, Consolidation and prediction of long-term treatment effect of group and online mindfulness-based cognitive therapy for distressed cancer patients. Acta Oncol. 2018 Oct; 57(10):1293-1302.

iii) Online fatigue relief

Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. This paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. The study found both web-based interventions effective for managing fatigue severity. 

Bruggeman‐Everts FZ, Wolvers MD, van de Schoot R, Vollenbroek‐Hutten MM, Van der Lee ML. Effectiveness of two web‐based interventions for chronic cancer‐related fatigue compared to an active control condition: Results of the “Fitter na kanker” randomized controlled trial. J Med Internet Res. 2017;19(10):e336.

iv) Online pain management

Chronic neuropathic pain (CNP) is a common condition cancer survivors experience. Mindfulness training may be one approach to address the psychosocial factors associated with CNP. An 8-week online mindfulness-based program was evaluated via interview. Participants reported an increase in perceived relaxation and calm, less pain and improved stress management.

Glynn BA, Khoo EL, MacLeay HML, Duong A, Cantave R, Poulin PA. Exploring Cancer Patients' Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation. Mindfulness (N Y). 2020;11(7):1666-1677. doi:10.1007/s12671-020-01380-z

v) Future directions for Apps

This study investigated ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects.

Huberty J, Puzia M, Eckert R, Larkey L. Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study. JMIR Cancer. 2020;6(1):e16926. Published 2020 Jan 25. doi:10.2196/16926


Starting in 1976, Dr Ainslie Meares published multiple case reports of remarkable remissions following intensive meditation practice. I happened to feature in one of those reports. It strikes me as remarkable that while in recent years there has been a large body of research published that clearly attests to the many benefits to quality of life that follow from  mindfulness and meditation practice amongst people affected by cancer, very few investigations have been made into the potential meditation might have to contribute to longer survival times, even cures. 

It does seem highly likely that a better quality of life translates into longer survival times, and some studies do support this proposition. However, it remains for the future for serious outcome studies to be pursued. Here is a summary of what is available so far…


i) Dr Ainslie Meares and intensive meditation

Meares published multiple case reports of remission from cancer following intensive meditation. Here are a few…

a) Breast cancer

Meares A. Med J of Aust. 1976, 2:184 

Meares A. Med J of Aust. 1977, 2:132-133 

Meares A. Med J of Aust. Correspondence, 10 Sept 1977 

b) Osteo-genic sarcoma - Meares reported my own remission :

Meares A. Med J Aust, 1978, 2:433

ii) Books on “Spontaneous Remission”

In 1993, the Institute of Noetic Sciences published the groundbreaking Spontaneous Remission: An Annotated Bibliography. The authors, Caryle Hirshberg and Brendan O’Regan, defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor.” The book assembled the largest database of medically reported cases of spontaneous remission in the world, with more than 3,500 references from more than 800 journals in 20 different languages. All the documents in the bibliography are downloadable from https://noetic.org/publication/spontaneous-remission-annotated-bibliography/.

While the book was very well received, many who featured in it objected to being described as “spontaneous remissions” as they felt they had contributed largely to their own recoveries. In consequence, Caryle Hirschberg interviewed many of the people featured (including myself) and coined a new term as the title for her subsequent book “Remarkable Recoveries”, published in 1995 along with co-author Marc Barasch.

More recently, in 2014, Kelly Turner published Radical Remission: Surviving Cancer Against All Odds where she too interviewed many long-term cancer survivors and analysed what common measures they linked to their unexpected recoveries.

From my own work, 2 books have been published recording “Radical Remissions” or “Remarkable Recoveries” :

Inspiring People – Stories of Remarkable Recovery and Hope, Edited by Ian Gawler, 1995 in which 43 stories are recounted.

Surviving Cancer – Inspiring Stories of Hope and Healing, Edited by Paul Kraus, 2008 in which 28 stories are recounted.


i) Breast cancer survival associated with depression levels 

See the Giese-Davis study above.

ii) Psychological and behavioural variables – a meta-analysis

This meta-analysis revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality. 

Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475. 


i) Prostate cancer

Revisit the work of Prof Dean Ornish at the start of this article that reported reversal of prostate cancer.

ii) The complex case of group therapy, quality of life and survival

Spiegel reported in the Lancet 1989, that attending a group based upon emotional expression weekly for one year, doubled survival time for women with secondary breast cancer and some participants survived over 10 years.

Another trial was performed by Fawzy with 68 patients with early stage malignant melanoma. At 6-year follow-up those who had usual care plus stress management showed a halving of recurrence and much lower death rate (than the group with only the usual surgical management). Both groups also had their immune function monitored which showed that after being originally comparable, the stress management group had significantly better immune function after six months.

Other studies have also yielded promising results in terms of longer survival for liver, gastrointestinal malignancies, and lymphoma but others have shown equivocal or negative results. The last of these trials was a large-scale attempt to replicate the findings of Spiegel. The results of this trial were negative despite the fact that the effects of the intervention had a positive effect on quality of life and mental health.

Of the five negative or equivocal trials mentioned above only two reported a positive effect on mental health and quality of life while all the studies that showed a positive effect on survival reported improved mental health and quality of life. Therefore, the trend seen in eight out of these 10 cancer studies seems to be similar to the findings in studies of psycho-social support in heart disease; where a psychosocial intervention improves quality of life and mental health it has the ‘side-effect’ of prolonging survival, while if there is marginal or no long-term benefit on mood or quality of life there is no corresponding improvement in survival.

     References for the above

Spiegel D et al. Lancet 1989;2:888-891.

Fawzy F. et al. Malignant melanoma; Effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival six years later. Arch Gen Psych 1993;50:681-89. 

Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of compliance with treatment on survival among patients with hematologic malignancies. J Clin Oncol 1990;8:356-64. 

Kuchler T. Henne-Bruns D. Rappat S. et al. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. Hepatogastroenterology. 1999;46:322-35. 

Ratcliffe MA, Dawson AA, Walker LG. Eysenck Personality Inventory L-scores in patients with Hodgkin's disease and non-Hodgkin's lymphoma. Psycho-oncology 1995;4:39-45. 

Cunningham AJ. Edmonds CV. Phillips C. et al. A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psychooncology.2000;9(4):323-39.

Edelman S. Lemon J. Bell DR. Kidman AD. Effects of group CBT on the survival time of patients with metastatic breast cancer. Psycho-Oncology. 1999;8(6):474-81. 

Ilnyckyj A, Farber J, Cheang MC, Weinerman BH. A randomized controlled trial of psychotherapeutic 
intervention in cancer patients. Ann R Coll Physicians Surg Can 1994;27:93-6.

Linn MW, Linn BS, Harris R. Effects of counseling for late stage cancer patients. Cancer 1982;49:1048-55. 

Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic 
breast cancer. N Engl J Med 2001;345:1719-26. 


My sense is if Dr Meares were still alive he would be delighted with how far meditation has come since his pioneering days. There is now a solid evidence base for mindfulness and meditation being used to help people affected by cancer  (including their carers) to overcome both the associated symptoms of cancer such as stress, anxiety, depression, pain management and fatigue as well as to assist in their treatment and recovery. 

Also, there is good evidence online mindfulness - based programs like our own Allevi8 App have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.

09 November 2020

Stroke, mindfulness and meditation - research evidence

Currently, one Australian has a stroke every 10 minutes. Every 10 minutes. Many, many families are affected. So is mindfulness and meditation likely to be helpful? Are people affected by stroke even capable of practicing mindfulness and meditation? Even more, what evidence is there an online program like our new, free Allevi8 App will be useful?

This week; the evidence – and it is positive!, but first 

      Thought for the day

Although the search for peace and fulfilment

Is temporarily alleviated by the acquisition

Of an object, substance, activity, state of mind or relationship,

It is never fully satisfied, and as a result, resurfaces 

As soon as the new experience ceases or disappears.

It is only when the apparently separate self or finite mind

Dives deep within itself that it finds

The rest, peace and the fulfilment

For which it longs.

                      Rupert Spira

While stroke is an emerging area of research, there is some good evidence for mindfulness and meditation – including on-line programs - facilitating improvements in both coping and recovery; and that carers can receive significant benefit.

1. Anxiety and depression

a) The scale of the problem amongst those affected by stroke

The prevalence of depression is reported to be very high among stroke survivors and has been associated with adverse clinical outcomes. 

A meta-analysis published in 2005 reported a pooled estimate of 33% for the prevalence of depression in stroke survivors (i). 

A multi-national study of 220 patients observed that the prevalence of depression remained as high as 33% for up to 5 years post stroke (ii). 

In addition, a review assessing post-stroke mortality reported increased odds of mortality for a period of 2 to 5 years among patients with depressive symptoms based on findings from 13 studies including 59,598 patients with stroke (iii). 

Previous research has suggested that the prevalence of depression and anxiety among carers is comparable to the observed prevalence levels among stroke survivors, and directly related to the severity of stroke (iv – vi). 

In addition, there is also evidence that stroke survivors and their carers mutually influenced each other’s emotional state (vii – viii).

i) Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:1330–1340. 

ii) Lincoln NB, Brinkmann N, Cunningham S, Dejaeger E, De Weerdt W, Jenni W, et al. Anxiety and depression after stroke: a 5 year follow-up. Disabil Rehabil. 2013;35:140–145. 

iii) Bartoli F, Lillia N, Lax A, Crocamo C, Mantero V, CarrĂ  G, et al. Depression after stroke and risk of mortality: a systematic review and meta-analysis. Stroke Res Treat. 2013;2013:862978. 

iv) Berg A, Palomaki H, Lonnqvist J, Lehtihalmes M, Kaste M. Depression among caregivers of stroke survivors. Stroke [Internet] 2005;36:639–643. 

v) Opara JA, Jaracz K. Quality of life of post-stroke patients and their caregivers. J Med Life. 2010;3:216–220.  

vi) Denno MS, Gillard PJ, Graham GD, DiBonaventura MD, Goren A, Varon SF, et al. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil [Internet] 2013;94:1731–1736. 

vii) McCarthy MJ, Lyons KS, Powers LE. Expanding poststroke depression research: movement toward a dyadic perspective. Top Stroke Rehabil [Internet] 2011;18:450–460

viii) Godwin KM, Ostwald SK, Cron SG, Wasserman J. Long-term health-related quality of life of stroke survivors and their spousal caregivers. J Neurosci Nurs [Internet] 2013;45:147–154. 

b) Mindfulness and meditation relieve anxiety and depression 

Several systematic reviews and meta-analyses support the use of mindfulness-based interventions (MBIs) (largely derived from MBSR) in helping people with long-term conditions (LTCs) to cope better with improvements in symptoms of anxiety and depression. 

Here are two… 

i) Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of Mindfulness-Based Stress Reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68:539–544. 

ii) Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78:169–183.

2. Mindfulness and meditation’s specific influence on stroke outcomes

A recent systematic review of the benefits of MBIs among patients with stroke, including four studies and 160 participants in total, concluded that a range of benefits may be derived from MBIs in this population. (i)

Another systematic review and critical appraisal of the evidence on the effectiveness of behavioural therapies such as yoga and mindfulness practices for stroke rehabilitation examined 5 randomized controlled clinical trials and 4 single case studies. Additionally, one qualitative research study was identified. Studies reported positive results, including improvements in cognition, mood, and balance and reductions in stress. The authors concluded yoga and mindfulness could be clinically valuable self-administered intervention options for stroke rehabilitation. (ii)

i) Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8:465–474. doi: 10.1111/ijs.12135. 

ii) Lazaridou A, Philbrook P, Tzika AA. Yoga and mindfulness as therapeutic interventions for stroke rehabilitation: a systematic review. Evid Based Complement Alternat Med. 2013;2013:357108. doi:10.1155/2013/357108

3. Can people affected by stroke actually practice mindfulness and meditation?

Clinical experience says yes, however, recently a small study did examine the feasibility of an adapted 2-week mindfulness meditation protocol for chronic stroke survivors. In addition, preliminary effects of this adapted intervention on spasticity and quality of life in individuals after stroke were explored. Exploratory preliminary analyses showed statistically significant improvements in spasticity, along with improvements in quality of life measures for Energy, Personality, and Work/Productivity.

Wathugala M, Saldana D, Juliano JM, Chan J, Liew SL. Mindfulness Meditation Effects on Poststroke Spasticity: A Feasibility Study. J Evid Based Integr Med. 2019 Jan-Dec;24:2515690X19855941. 

4. Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the effectiveness of online Mindfulness Based Interventions (MBIs) on mental health. Results showed online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  


There is a solid evidence base for mindfulness and meditation being used to help people affected by stroke (including their carers) to overcome both the associated symptoms of stroke such as stress, anxiety and depression, as well as to assist in their recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.

02 November 2020

What evidence is there mindfulness and meditation reduce stress, anxiety and depression; improve mental and emotional health?

Want key scientific articles to share with family, friends or health professionals who need convincing? Need a little reassurance yourself??? 

Currently if one searches “mindfulness and meditation research”, Google comes up with around 17.6 million results. A bit daunting - so here are some of the top, recent articles (mostly meta- analyses) that make the case very clearly - with links to the actual articles, but first as an offering to voters in the USA this week and for all of us in general, two takes on a well known classic…

      Thought for the day

God grant me the serenity 

To accept the things I cannot change,

The strength to change the things I can,

And the wisdom to know the difference.

     The serenity prayer – Reinhold Niebuhr

God grant me the serenity

To accept the people I cannot change

The courage to change the one that I can 

And the wisdom to know it is me.


Clearly mindfulness and meditation are areas of great interest amongst the medical research community as well as the general public. On our free mindfulness and meditation based Allevi8 app, claims are made that therapeutic benefits can be derived from mindfulness and meditation for

1. Reducing stress, anxiety and depression

2. Reducing disease related symptoms 

3. Accelerating healing

4. Pain relief

5. Alleviating nausea

6. Reducing fatigue

7. Improving emotional and mental health

While the quality of 17.6 million results varies quite a deal, there is a large volume of credible research in support of the Allevi8 claims. Over the next few weeks this blog will provide summaries of key articles that add to the evidence base for the App, starting in this post relating to mental health issues. 

These articles are documented on the Allevi8 App’s website Allevi8.net.

1.  Reducing Stress and Anxiety – via online mindfulness

Spijkerman MP et al. 2016, Clin Psych review, Vol 45, 102 114.

Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials.  

The authors reported online Meditation- Based Interventions have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.

2. Reducing stress and anxiety – meditation

Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68. doi: 10.1001/jamainternmed.2013.13018.

This meta-analysis reviewed 18,753 citations, however, only 47 trials with 3515 participants met the stringent criteria to be included in the final analysis – having randomized clinical trials with active controls for placebo. 

The authors concluded meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Specifically, there was found to be moderate evidence of improved anxiety, depression and pain, with lower evidence of improved stress/distress and mental health-related quality of life. 

3. Reducing Stress and Anxiety – Mindfulness Based Therapy

Khoury B et al. Mindfulness-based therapy: A comprehensive meta-analysis; 2013 Clin Psych Review vol 33, 6, 763 - 771.

Meta-analysis (review) of studies evaluating Mindfulness Based Therapy – a specific form of mindfulness. The authors concluded “MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.”

4. Reducing psychological distress

Coffey, K. A., & Hartman, M. (2008). Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress. Complementary Health Practice Review, 13(2), 79–91. https://doi.org/10.1177/1533210108316307

The authors reported their results confirmed an inverse relationship between mindfulness and psychological distress.

5. Anxiety, mood disorders and accelerating healing

Arias et al. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006;12(8):817‐832. doi:10.1089/acm.2006.12.817

While there have been few studies examining the specific question of meditation’s influence on healing in general, early studies are positive.

The authors reported the strongest evidence for efficacy was found for epilepsy, symptoms of the premenstrual syndrome and menopausal symptoms. 

Benefit was also demonstrated for mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. They stated their results support the safety and potential efficacy of meditative practices for treating certain illnesses, particularly in nonpsychotic mood and anxiety disorders. 

6. Reducing depression and fatigue; improving sleep

Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(4):494–501. doi:10.1001/jamainternmed.2014.8081

Following this randomised clinical trial, the author’s reported Mindfulness Awareness Practices showed significant improvement relative to the Sleep Hygiene Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity. 

7. Stress, anxiety and depression reduction; improvements in mental and physical health

From American Psychological Association website, 2019

Creswell JD and Khoury B. Mindfulness meditation: A research-proven way to reduce stress : Mindfulness meditation can improve both mental and physical health.

Researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for reducing stress, anxiety and depression. Mindfulness can also help treat people with specific problems including depression, pain, smoking and addiction. 

Some of the most promising research has looked at people with depression. Several studies have found, for example, that MBCT can significantly reduce relapse in people who have had previous episodes of major depression. 

What is more, mindfulness-based interventions can improve physical health, too. For example, mindfulness may reduce pain, fatigue and stress in people with chronic pain. Other studies have found preliminary evidence that mindfulness might boost the immune system and help people recover more quickly from cold or flu.

8. Depression and burn-out

Research on Mindfulness Based Cognitive Therapy (MBCT) has found that these techniques more than halve the relapse rate for people who have had depression - from 78% to 36%. Meditation changes our relationship to negative thoughts and emotions giving a non-attachment to them and therefore, we are not controlled by them so much.

In adolescents, mindfulness reduces symptoms of anxiety, depression, and somatic distress, and increases self-esteem and sleep quality.

For professionals with high stress loads such as doctors, Mindfulness has also been found to enhance wellbeing, reduce burnout and mood disturbance with increased empathy and responsiveness to their patients.


Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects: J Consult Clin Psychol. 2004;72(1):31-40

Biegel et al. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial: Journal of consulting and clinical psychology (2009) vol. 77 (5) pp. 855-66.

Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians: JAMA. 2009 Sep 23;302(12):1338-40. 

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.