The effects of meditation on individuals facing loneliness ...
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Saini et al. BMC Psychol (2021) 9:88 https://doi.org/10.1186/s40359-021-00585-8 RESEARCH ARTICLE The effects of meditation on individuals facing loneliness: a scoping review Gurleen K. Saini , Saud B. Haseeb , Zhala Taghi‑Zada and Jeremy Y. Ng * Abstract Background: Meditation is defined as a mind and body practice focused on interactions between the brain, mind, body, and behaviour, containing four key elements: a quiet location with little distractions, a comfortable posture, a focus of attention, and an open attitude. We sought to review the benefits of meditation on the alleviation of loneliness. Methods: A scoping review was conducted based on Arksey and O’Malley’s five‑stage framework. Eligibility criteria included primary studies of any type that investigated the effects of meditation on loneliness. Search strategies were developed and conducted on MEDLINE, EMBASE, AMED, and CINAHL. The National Center for Complementary and Integrative Health, and American Psychological Association websites were also searched. Articles meeting the inclu‑ sion criteria were critically reviewed using a descriptive‑analytical narrative method. Results: Thirteen studies met our inclusion criteria and were published between 2012 and 2020 across 10 countries. Eleven studies reported improvements in relation to loneliness. Of the remaining two studies (15%), one mentioned the alleviation of loneliness, but only looked primarily at social closeness in lonely individuals. The other study found a correlation between loneliness and nuclear factor (NF)‑κB levels, which was the measured outcome; however, the direct effects of meditation on loneliness were unclear. Three main themes emerged from our analysis, as follows: 1) positive results across all studies, 2) relatively small randomized control trials conducted over the last decade, and 3) lack of diverse demographic information. Conclusions: While a small number of studies exist at this intersection, given all included studies indicated posi‑ tive findings, the effects of meditation in alleviating loneliness are promising. Future research should be directed at understanding how meditation mitigates loneliness and how this intervention can impact practice for healthcare professionals. Keywords: Loneliness, Meditation, Mind–body medicine, Mindfulness, Scoping review © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Background Meditation is defined as a mind and body practice focused on interactions between the brain, mind, body, and behaviour, containing four key elements: a quiet location with little distractions, a comfortable posture, a focus of attention, and an open attitude [1]. Meditation is often used for its various health benefits, specifically the alleviation of certain mental states, such as loneliness [2]. While meditation has become popular in Western countries and has been a staple in many Eastern cultures, including Buddhism, due to its positive benefits on men- tal health, these benefits are not clearly defined in many cases [3, 4]. Over recent years, an increasing number of clini- cally relevant studies have been conducted in the field of meditation, shedding light on its effects on various Open Access *Correspondence: [email protected] Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
Transcript of The effects of meditation on individuals facing loneliness ...
Saini et al. BMC Psychol (2021) 9:88 https://doi.org/10.1186/s40359-021-00585-8
RESEARCH ARTICLE
The effects of meditation on individuals facing loneliness: a scoping reviewGurleen K. Saini , Saud B. Haseeb , Zhala Taghi‑Zada and Jeremy Y. Ng*
Abstract
Background: Meditation is defined as a mind and body practice focused on interactions between the brain, mind, body, and behaviour, containing four key elements: a quiet location with little distractions, a comfortable posture, a focus of attention, and an open attitude. We sought to review the benefits of meditation on the alleviation of loneliness.
Methods: A scoping review was conducted based on Arksey and O’Malley’s five‑stage framework. Eligibility criteria included primary studies of any type that investigated the effects of meditation on loneliness. Search strategies were developed and conducted on MEDLINE, EMBASE, AMED, and CINAHL. The National Center for Complementary and Integrative Health, and American Psychological Association websites were also searched. Articles meeting the inclu‑sion criteria were critically reviewed using a descriptive‑analytical narrative method.
Results: Thirteen studies met our inclusion criteria and were published between 2012 and 2020 across 10 countries. Eleven studies reported improvements in relation to loneliness. Of the remaining two studies (15%), one mentioned the alleviation of loneliness, but only looked primarily at social closeness in lonely individuals. The other study found a correlation between loneliness and nuclear factor (NF)‑κB levels, which was the measured outcome; however, the direct effects of meditation on loneliness were unclear. Three main themes emerged from our analysis, as follows: 1) positive results across all studies, 2) relatively small randomized control trials conducted over the last decade, and 3) lack of diverse demographic information.
Conclusions: While a small number of studies exist at this intersection, given all included studies indicated posi‑tive findings, the effects of meditation in alleviating loneliness are promising. Future research should be directed at understanding how meditation mitigates loneliness and how this intervention can impact practice for healthcare professionals.
Keywords: Loneliness, Meditation, Mind–body medicine, Mindfulness, Scoping review
© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
BackgroundMeditation is defined as a mind and body practice focused on interactions between the brain, mind, body, and behaviour, containing four key elements: a quiet location with little distractions, a comfortable posture, a
focus of attention, and an open attitude [1]. Meditation is often used for its various health benefits, specifically the alleviation of certain mental states, such as loneliness [2]. While meditation has become popular in Western countries and has been a staple in many Eastern cultures, including Buddhism, due to its positive benefits on men-tal health, these benefits are not clearly defined in many cases [3, 4].
Over recent years, an increasing number of clini-cally relevant studies have been conducted in the field of meditation, shedding light on its effects on various
Open Access
*Correspondence: [email protected] of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, Room 2112, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
Page 2 of 30Saini et al. BMC Psychol (2021) 9:88
mechanisms, specifically the neurobiological mecha-nisms called S-ART [5]. This refers to self-awareness, self-regulation, and self-transcendence [5]. Meditative practices overall focus on navigating difficult emotions and feelings [6]. Mindfulness practices, such as loving-kindness meditation specifically, which helps to create unconditional kind attitudes towards others and oneself [7], has been shown by Hutcherson et al. [8] to increase feelings of social connectedness and consequently decrease feelings associated with social isolation. There-fore, mindfulness meditation training can be a successful tool to implement in order to reduce feelings of isolation due to the downregulation of the expression of inflam-mation-related genes, which are parallel to reductions in loneliness [9].
While there is no universal definition for the term ‘loneliness’, it is commonly defined as a state of solitude or being alone [10]. Loneliness can also be defined as the perception of being alone, which constitutes having a negative state of mind associated with deficient social relations rather than actually being alone, due to the vari-ous forms of loneliness that exist: (1) chronic loneliness and (2) reactive loneliness [10, 11].
Currently, loneliness is likely to be exacerbated as a result of the coronavirus disease 2019 (COVID-19) pan-demic, due to a decrease in regular modes of commu-nication, such as intimate interactions and face-to-face contact, as well as due to a more vulnerable aging popu-lation, who, under normal circumstances, disproportion-ately face loneliness [12, 13]. Before the World Health Organization declared the COVID-19 pandemic [14], the prevalence rates of loneliness and social isolation were already known to be between 10–40% across the United States, China and various European countries, that it was being described as a “behavioral epidemic” [15]. This was specifically being seen in older adults, with both condi-tions co-occurring frequently [15]. The susceptibility of loneliness in older adults is due to various factors, such as living alone or a lack of familial connections, reduced connections to one’s culture of origin, loss of friendship networks and associated problems in creating new ones, among others [13].
During the beginning of the pandemic between Janu-ary and May of 2020, there had already been a statistically significant increase in loneliness (interaction-p = 0.018) measured based upon a three-item Loneliness Scale, which included the 3 following items: feeling “that you lack companionship”, “left out”, and “isolated from oth-ers” [16]. This was most often associated with a reduction in social supports, resulting from the pandemic-associ-ated restrictions that were implemented [16]. As such, negative behavioural health impacts associated with the pandemic posed a threat of worsening after the initial
outbreak, including loneliness, which can cause increases in depressive symptoms [16]. While it is challenging to fully identify the extent to which this has occurred to date, evidence exists suggesting that lockdown policies and self-isolation protocols have been found to have negative impacts on the levels of loneliness experienced by individuals both during and after lockdown [17]. Due to the increasing public health issue of loneliness and its effects on health and well-being, alleviation of feelings of loneliness through therapies of value can result in posi-tive health outcomes, such as a lower risk for physiologi-cal dysregulation and inflammation [18]. The pandemic has also brought with it an increase in the usage of medi-tation apps [19]. While it is known that loneliness causes adverse health outcomes and meditation has been linked to its alleviation, the sum benefits identified by research remain unknown. To date, the quantity and type of stud-ies investigating the effects of meditation on loneliness has not been indicated by the literature. Therefore, this was the purpose of this study, using a scoping review methodology.
MethodsApproachScoping reviews are used to review a body of literature and are defined as studies that aim to map the litera-ture on a particular topic or research area and provide an opportunity to identify key concepts; gaps in the research; and types and sources of evidence to inform practice, policymaking, and research [20]. A scoping review investigating the effects of meditation on loneli-ness was conducted based on Arksey and O’Malley’s [21] five-stage scoping review framework. The five steps are as follows: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarizing, and reporting the results.
Step 1: identifying the research questionThe purpose of the present scoping review was to identify the quantity and type of studies investigating the effects of meditation on loneliness. Study eligibility was based on a Population, Intervention, Comparison and Out-comes (PICO) framework. Eligible populations included adults aged 18 years and older experiencing loneliness. With respect to interventions, meditation and other mindfulness related practices, such as mindfulness-based stress reduction (MBSR) were the focus of this study and the basis for eligibility; we excluded any therapies with no meditation-specific component (i.e. yoga as a form of exercise). There were no comparisons. Outcomes included a summarization and thematic analysis of find-ings across all eligible articles.
Page 3 of 30Saini et al. BMC Psychol (2021) 9:88
Step 2: finding relevant studiesFollowing preliminary searches of the literature, search strategies were developed for and conducted on MED-LINE, EMBASE, AMED, and CINAHL databases. The National Centre for Complementary and Integrative Health (NCCIH), and the American Psychological Asso-ciation (APA) websites were also searched for eligible pri-mary research articles and scoping or systematic reviews evaluating outcomes on use of meditation in individu-als facing loneliness. Reference lists of scoping and sys-tematic reviews were also reviewed for other potentially eligible primary research articles not captured by our search strategies. The search, designed by GKS and JYN, included literature published from database inception up and including the week of April 22, 2020. Terms searched included “breathing exercise(s)”, “loneliness”, “medita-tion”, “mind–body therap(ies)”, “mindfulness”, “patient isolation”, “relaxation therap(ies)”, “social distance”, and “social isolation”. These terms were identified following a review of indexed headings and keywords of articles found in our preliminary searches. A sample search strat-egy is provided in Table 1.
Step 3: selecting the studiesOnly primary research articles evaluating the effect of meditation on loneliness were included for the purpose of this scoping review. Articles were excluded at this stage if they did not make reference to our research objective of alleviating loneliness using meditation. If studies iden-tified or measured outcomes resulting from the effects of meditation on loneliness, they met our inclusion criteria;
this was true regardless of whether these aforementioned outcomes were designated by the study as primary or sec-ondary. Publications in the form of protocols, abstracts, letters, editorials, case reports or case series were not eli-gible. We also restricted our eligibility criteria to articles published in the English language, those that involved adult populations (aged 18 +), and that were either avail-able publicly or could be ordered through the McMaster University library system. All authors (GKS, SBH, ZT, and JYN) initially pilot-screened a subset of the titles and abstracts independently and then met to discuss and resolve discrepancies. Following deduplication, all search results were independently screened in triplicate (GKS, SBH, and ZT). All four authors then met, and any discrepancies were resolved; in the case that a consensus could not be reached, a majority vote was held (between GKS, SBH, and ZT) following discussion with the super-vising author (JYN).
Step 4: charting the dataThe articles that met the inclusion criteria were critically reviewed using Arksey and O’Malley’s descriptive-analyt-ical narrative method [21]. For each eligible article that was included, the following data was then extracted and charted: article title, author(s), year of publication, study country, study setting, study design, population type and sample size, definition of loneliness, type of meditation used, duration of meditation, the occurrence of a follow-up (and duration), primary and secondary outcomes and how they were measured, main findings, challenges encountered, and conclusion. GKS and JYN developed the data extraction forms. GKS, SBH, and ZT completed data extraction for a subset of the eligible articles and then met to discuss and resolve any discrepancies. This was followed by the three authors (GKS, SBH, and ZT) completing a full data extraction of all the eligible articles independently and meeting to discuss and resolve any discrepancies, with JYN resolving discrepancies within both the pilot and final data extraction sets when a con-sensus was unable to be reached.
Step 5: collating, summarizing, and reporting the resultsCharted data was summarized in the format of tables, fol-lowed by descriptive data being analyzed using thematic analysis. GKS reviewed the entire set of data, while SBH and ZT reviewed subsets of the data. JYN and GKS iden-tified codes relative to the findings, organized codes into thematic groups, and presented a narrative relating to the research question, as well as highlighted knowledge gaps in the currently existing literature. All four authors then met to discuss and resolve discrepancies.
Table 1 MEDLINE search strategy for primary studies examining the effects of meditation on loneliness executed April 28, 2020
Database: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions(R) <1946 to April 22, 2020>
Search strategy
1 Loneliness.mp. or Loneliness/ (7054)
2 Social distance.mp. or Social Distance/ (3387)
3 Social isolation.mp. or Social Isolation/ (17,414)
4 Patient isolation.mp. or Patient Isolation/ (4045)
5 Or/1–4 (30,399)
6 Breathing Exercises/ or breathing exercise*.mp. (3974)
7 Meditation.mp. or Meditation/ (5937)
8 Mindfulness.mp. or Mindfulness/ (7708)
9 Mind–Body Therapies/ or mind–body therap*.mp. (1289)
10 Relaxation Therapy/ or relaxation therap*.mp. (6671)
11 Or/6–10 (21,834)
12 5 and 11 (94)
13 Limit 12 to english language (91)
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ResultsSearch resultsSearches identified a total of 500 items, of which 390 were unique, and 347 titles/abstracts were eliminated, leaving 43 full-text articles to be considered. Of those, 30 were not eligible, because they did not evaluate loneliness using a meditation intervention (n = 17) or were a non-eligible publication type (n = 13), resulting in a total of 13 eligible articles [9, 22–33]. A PRISMA diagram depicting this process is shown in Fig. 1.
Eligible article characteristicsThirteen studies met the inclusion criteria and were pub-lished between 2012 and 2020 and conducted across 10 countries [9, 22–33]. These articles originated from the United States (n = 7); Australia (n = 1); Germany (n = 1); India, Nepal, Myanmar, and Sri Lanka (n = 1); Iran (n = 1); South Korea (n = 1); and Spain (n = 1). Of the 13 articles, 8 were randomized controlled trials (RCTs), 2 were feasibility studies with an RCT design, 1 was a feasi-bility and acceptability study, 1 was a pilot study looking at feasibility, and 1 was a quasi-experimental study. Six of the 13 studies (46%) used meditation in combination with other interventions, such as yoga. The remaining 7 stud-ies (54%) used meditation as the only intervention, the types of which included cognitively based compassion training, brain education-based meditation, tai chi medi-tation, and mindfulness-based stress reduction training. Ten out of 13 studies (77%) looked at loneliness in some aspect as a primary outcome, while 3 out of 13 studies (23%) looked at loneliness as a secondary outcome. Gen-eral characteristics of all eligible studies are found in Table 2 and details specific to findings and outcomes are found in Table 3. Additional demographic characteristics of all eligible studies are provided in Table 4.
Summary of eligible article findingsEighty-five percent of the studies (11 out of 13) identi-fied positive improvements in participants’ feelings of loneliness. Of the two remaining studies, one mentioned the alleviation of loneliness, but only looked primarily at social closeness in individuals experiencing loneliness. The other study found a correlation between loneliness and participants’ nuclear factor (NF)-κB levels, which was the measured outcome; however, the direct effects of meditation for loneliness were unclear.
Findings from thematic analysisIn total, three main themes emerged from our review and are described below.
Positive results across all studiesUpon accounting for all eligible articles, one immedi-ate and striking finding included that all thirteen of the studies reported positive findings for at least one of their respective outcomes [9, 22–33]. Of these studies, 11 out of 13 (85%) studies identified improvements in relation to loneliness [9, 22–27, 29–31, 33]. Of these 11 studies, 7 (64%) studies identified a significant decrease in lone-liness within their intervention groups [9, 22–24, 26, 27, 29]. Lindsay et al. also found significant decreases in loneliness, however, only in one of the two intervention groups within the study that had used meditative tech-niques (monitor and acceptance) [25]. Eighteen percent of the studies (2 out of 11) found positive but insignifi-cant decreases in loneliness [30, 31]. Jazaieri et al. found improvements in clinical symptoms, such as loneliness, in both its RCT and untreated social anxiety disorder group [33]. It is also important to note that loneliness (and its alleviation) was not measured uniformly across the 11 studies. The following measures were used to “quantify”
MEDLINE
(n=91)
EMBASE
(n=234)
Records after duplicates removed
(n=390)
Titles/abstracts excluded
(n=347)
CINAHL*
(n=105)
APA*
(n=30)
NCCIH*
(n=39)
Titles/abstracts included based on eligibility
(n=43)
Number of full-text articles included and data extracted
(n= 13)
Full text articles excluded (n=30)
• No direct measure of meditation on
loneliness (n=17)
• Other non-eligible publication type
(n=13)
AMED*
(n=1)
Fig. 1 PRISMA diagram. CINAHL Cumulative Index to Nursing and Allied Health Literature, APA American Psychological Association, NCCIH National Center for Complementary and Integrative Health, AMED Allied and Complementary Medicine
Page 5 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
Gen
eral
cha
ract
eris
tics
of e
ligib
le s
tudi
es
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Broo
ker e
t al.
2020
[22]
A fe
asib
ility
and
ac
cept
abili
ty
stud
y of
an
adap
tatio
n of
th
e M
indf
ul
Self‑
Com
pas‑
sion
pro
gram
fo
r adu
lt ca
n‑ce
r pat
ient
s
Aus
tral
iaEd
ucat
ion
and
rese
arch
inst
i‑tu
te b
uild
ing
Feas
ibili
ty a
nd
acce
ptab
ility
st
udy
Patie
nts
who
ha
d re
ceiv
ed a
di
agno
sis
of n
on‑
adva
nced
can
cer
in th
e pr
evio
us
6 m
onth
s—5
year
s, w
ho re
side
d w
ithin
60
km
of t
he
inte
rven
tion
venu
e,
wer
e flu
ent i
n En
glis
h, a
ntic
ipat
ed
that
they
cou
ld
atte
nd a
t lea
st fo
ur
of th
e M
indf
ul S
elf‑
Com
pass
ion
(MSC
) gr
oup
sess
ions
, an
d w
ere
able
to
prov
ide
writ
ten
info
rmed
con
sent
; ss
: n =
30
at th
e be
ginn
ing
of th
e st
udy,
n =
27
at
conc
lusi
on
No
defin
ition
pr
ovid
edW
ritte
n re
flec‑
tive
prac
tices
an
d gu
ided
m
edita
tions
su
ppor
ted
by
audi
o‑re
cord
‑in
gs m
ade
avai
labl
e by
th
e pr
ogra
m
deve
lop‑
ers +
dai
ly
hom
ewor
k co
mpo
nent
of
appr
oxim
atel
y 20
min
of
both
info
rmal
an
d fo
rmal
se
lf‑co
m‑
pass
ion
and
min
dful
ness
pr
actic
es
(i.e.
cor
e m
edita
tion,
lo
ving
‑kin
d‑ne
ss, o
peni
ng
med
itatio
n,
med
itatio
n:
com
pas‑
sion
for s
elf
and
othe
rs).
Gro
up‑
base
d an
d in
stru
ctor
‑led
MSC
pro
gram
ad
apte
d to
can
cer
patie
nts,
face
‑to
‑face
At l
east
4
sess
ions
of
105
min
, de
liver
ed
wee
kly.
The
re‑
fore
4 w
eeks
. M
inim
um
atte
ndan
ce
requ
ired
of 4
se
ssio
ns o
ut
of 8
, so
coul
d ha
ve g
one
up
to 8
wee
ks
No
Not
app
licab
le
Page 6 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Rodr
igue
z‑Ro
mer
o et
al.
2020
[23]
Inte
rven
tion
to re
duce
pe
rcei
ved
lone
lines
s in
co
mm
unity
‑dw
ellin
g ol
der
peop
le
Spai
nU
rban
prim
ary
heal
thca
re
cent
er
Rand
omiz
ed
clin
ical
tria
l w
ithou
t blin
d ev
alua
tion
Com
mun
ity d
wel
lers
w
ith m
oder
ate
to
seve
re p
erce
ived
lo
nelin
ess
(acc
ord‑
ing
to U
CLA
Sca
le)
and
mod
erat
e au
tono
my
or
depe
nden
ce
(acc
ordi
ng to
Ba
rthe
l Ind
ex);
ss:
n =
55
Look
ed a
t pe
rcei
ved
lone
lines
s. "L
onel
ines
s, a
subj
ectiv
e ph
enom
enon
de
rived
from
th
e di
scre
p‑an
cy b
etw
een
the
leve
l of
soci
al c
onta
ct
achi
eved
and
th
at d
esire
d,
is d
escr
ibed
as
a p
ainf
ul
expe
rienc
e ac
com
pani
ed
by n
egat
ive
feel
ings
."
Gro
up‑b
ased
m
indf
ulne
ss
sess
ion/
wor
ksho
p to
redu
ce
or m
inim
ize
stre
ss (f
ace‑
to‑
face
)
18 s
essi
ons
over
6
mon
ths
No
Not
app
licab
le
Lee
et a
l. 20
19
[24]
Brai
n ed
uca‑
tion‑
base
d m
edita
tion
for
patie
nts
with
hy
pert
ensi
on
and/
or ty
pe 2
di
abet
es
Sout
h Ko
rea
Publ
ic h
ealth
ce
nter
Pilo
t non
‑bl
inde
d ra
ndom
ized
co
ntro
l tria
l (R
CT)
48 p
atie
nts
with
hy
pert
ensi
on a
nd/
or ty
pe 2
dia
be‑
tes;
24 to
Bra
in
Educ
atio
n‑ba
sed
Med
itatio
n (B
EM)
and
24 to
hea
lth
educ
atio
n—at
co
mpl
etio
n th
ere
wer
e 14
in c
ontr
ol
and
21 in
BEM
; ss:
tota
l of 3
5 po
st‑
inte
rven
tion
No
defin
ition
pr
ovid
edIn
stru
ctor
‑led
BEM
, whi
ch is
a
tech
niqu
e kn
own
to
chan
ge b
rain
st
ruct
ure,
psy
‑ch
olog
y, a
nd
phys
iolo
gy o
f he
alth
y ad
ult
part
icip
ants
. G
roup
cla
sses
8 w
eeks
No
Not
app
licab
le
Page 7 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Lind
say
et a
l. 20
19 [2
5]M
indf
ulne
ss
trai
ning
re
duce
s lo
nelin
ess
and
incr
ease
s so
cial
co
ntac
t in
a ra
ndom
ized
co
ntro
lled
tria
l
Uni
ted
Stat
esSm
art‑
phon
e de
liver
ed
inte
rven
tion
(rem
ote,
at‑
hom
e st
udy
activ
ities
)
Thre
e‑ar
m
rand
omiz
ed
cont
rolle
d di
sman
tling
tr
ial
153
heal
thy
but
stre
ssed
Eng
lish‑
spea
king
adu
lts
who
ow
ned
smar
t‑ph
ones
No
defin
ition
pr
ovid
edSm
artp
hone
ba
sed
less
ons
cons
istin
g of
trai
ning
in
eith
er: m
oni‑
torin
g an
d ac
cept
ance
, m
onito
ring
only
, or a
ctiv
e co
ntro
l tra
in‑
ing.
Les
sons
co
nsis
ted
on
20‑m
in o
f au
dio
in a
ddi‑
tion
to b
rief
hom
ewor
k pr
actic
e
2 w
eeks
No
Not
app
licab
le
Page 8 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Pand
ya 2
019
[26]
Med
itatio
n pr
ogra
m
miti
gate
s lo
nelin
ess
and
prom
otes
w
ellb
eing
, life
sa
tisfa
ctio
n an
d co
nten
t‑m
ent a
mon
g re
tired
old
er
adul
ts: A
two‑
year
follo
w‑u
p st
udy
in fo
ur
Sout
h A
sian
ci
ties
Indi
a, N
epal
, M
yana
mar
, Sri
Lank
a
Volu
ntar
y ag
en‑
cies
loca
ted
in e
ach
of th
e 4
Sout
h A
sian
ci
ties
RCT
Retir
ed o
lder
adu
lt m
embe
rs (r
etire
d fo
r 2–5
yea
rs a
t sta
rt
of s
tudy
); ss
: Pos
t‑te
st, 1
66 re
mai
ned
with
inte
rven
tion
and
157
with
con
‑tr
ol (n
= 3
23)
Lone
lines
s is
th
e pe
rcei
ved
abse
nce
of
posi
tive
soci
al
rela
tions
hips
an
d in
timat
e re
latio
n‑sh
ips,
varie
s ba
sed
on
pers
onal
and
co
ntex
tual
de
term
inan
ts
and
is a
neg
a‑tiv
e em
otio
nal
expe
rienc
e.
Lone
lines
s is
an
out
com
e of
the
subj
ec‑
tive,
cog
nitiv
e ev
alua
tion
of
ther
e be
ing
a m
ism
atch
be
twee
n th
e qu
ality
and
qu
antit
y of
ex
istin
g re
la‑
tions
hips
on
the
one
hand
, an
d re
latio
n‑sh
ip s
tand
ards
on
the
othe
r
Cust
omiz
ed
med
itatio
n pr
ogra
m
(inst
ruct
or‑
led
and
in
grou
ps),
the
key
feat
ures
of
whi
ch w
ere:
(i)
post
ures
inte
r‑sp
erse
d w
ith
rela
xatio
n, (i
i) sl
owne
ss in
m
ovem
ents
an
d, (i
ii) in
ner
wat
chfu
l aw
aren
ess.
This
cus
tom
‑iz
ed m
edita
‑tio
n pr
ogra
m
com
pris
ed
a 45
‑min
gu
ided
less
on
cond
ucte
d on
ce a
wee
k by
inst
ruct
ors
and
the
sam
e w
as to
be
prac
ticed
at
hom
e by
the
part
icip
ants
on
ce a
wee
k pr
ior t
o th
e ne
xt c
lass
(in
divi
dual
ly)
2 ye
ars
No
Not
app
licab
le
Mas
caro
et a
l. 20
18 [2
7]M
edita
tion
buff‑
ers
med
ical
st
uden
t com
‑pa
ssio
n fro
m
the
dele
teri‑
ous
effec
ts o
f de
pres
sion
Uni
ted
Stat
esM
edic
al s
choo
l ca
mpu
sFe
asib
ility
st
udy
with
ra
ndom
ized
si
ngle
‑blin
d w
ait‑
list c
on‑
trol
led
tria
l
11 in
wai
t‑lis
t and
21
in C
BCT =
32
com
‑pl
eted
stu
dy (5
9 in
itial
ly e
nrol
led)
No
defin
ition
pr
ovid
ed b
ut
it is
spe
ci‑
fied
to b
e ex
perie
nced
by
med
ical
st
uden
ts
expe
rienc
ing
burn
out
CBC
T (c
on‑
sist
ing
of
in‑p
erso
n in
stru
ctor
‑led
grou
p cl
asse
s in
add
ition
to
at‑
hom
e pr
actic
e)
10 w
eeks
No
Not
app
licab
le
Page 9 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Kok
et a
l. 20
17
[28]
Effec
ts o
f co
ntem
pla‑
tive
dyad
s on
en
gage
men
t an
d pe
rcei
ved
soci
al c
on‑
nect
edne
ss
over
9 m
onth
s of
men
tal
trai
ning
Ger
man
yN
ot s
peci
fied
(bot
h on
line
and
in‑p
erso
n in
terv
entio
ns
took
pla
ce)
RCT
242
heal
thy
part
ici‑
pant
s af
ter e
xclu
d‑in
g pa
rtic
ipan
ts
with
not
app
licab
le
data
A p
erce
ived
lack
of
soc
ial c
on‑
nect
edne
ss
Secu
lariz
ed c
las‑
sica
l sol
itary
m
edita
tion
trai
ning
mod
‑ul
es m
ade
up
of: b
reat
hing
m
edita
tion
and
body
sc
an (t
he p
res‑
ence
mod
ule)
, lo
ving
‑kin
d‑ne
ss m
edita
‑tio
n an
d aff
ect d
yad
(the
affe
ct
mod
ule)
, and
ob
serv
ing‑
thou
ghts
m
edita
tion
and
pers
pec‑
tive
dyad
(the
pe
rspe
ctiv
e m
odul
e) o
n w
ebsi
te a
nd
phon
e ap
p—co
nsis
ting
of
an in
‑per
son
3‑da
y re
trea
t, on
line
indi
vid‑
ual m
odul
es
and
guid
ed
med
itatio
ns,
and
onlin
e 2‑
pers
on d
yad
trai
ning
9‑m
onth
ope
n‑la
bel e
ffica
cy
tria
l of t
hree
, 3‑
mon
th
secu
lariz
ed
men
tal t
rain
‑in
g m
odul
es
No
Not
app
licab
le
Page 10 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Tkat
ch e
t al.
2017
[29]
A p
ilot o
nlin
e m
indf
ulne
ss
inte
rven
tion
to d
ecre
ase
care
give
r bu
rden
and
im
prov
e ps
ycho
logi
cal
wel
l‑bei
ng
Uni
ted
Stat
es2
loca
l com
mu‑
nity
cen
ters
Pilo
t stu
dy
exam
inin
g fe
asib
ility
of
inte
rven
tion
Com
mun
ity‑d
wel
ling
olde
r adu
lt ca
regi
v‑er
s (n
= 4
0)
No
defin
ition
pr
ovid
edO
nlin
e m
indf
ulne
ss
inte
rven
tion;
co
mbi
natio
n of
edu
catio
n,
min
dful
ness
m
edita
tion,
an
d se
lf‑ca
re,
whi
ch p
rimar
‑ily
focu
sed
on s
elf‑
com
pass
ion.
Ei
ght m
odul
es
wer
e de
liv‑
ered
twic
e w
eekl
y on
line,
ut
ilizi
ng
phon
e an
d w
eb‑in
terf
ace
to a
n on
line
lear
ning
pl
atfo
rm th
at
cont
aine
d se
s‑si
on m
ater
ials
, do
wnl
oada
ble
brie
f med
ita‑
tion
prac
tices
, ac
cess
to
shor
t lea
rnin
g vi
deos
, and
ot
her s
uppo
rt
tool
s. 3
of th
e m
odul
es w
ere
also
del
iver
ed
in‑p
erso
n to
pro
vide
al
tern
ativ
e to
uch
poin
ts
if pa
rtic
ipan
ts
wer
e ab
le to
at
tend
and
pr
efer
red
this
m
etho
d
8 w
eeks
No
Not
app
licab
le
Page 11 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Dod
ds e
t al.
2015
[30]
Feas
ibili
ty o
f Co
gniti
vely
‑Ba
sed
Com
‑pa
ssio
n Tr
ain‑
ing
(CBC
T) fo
r br
east
can
cer
surv
ivor
s: a
rand
omiz
ed,
wai
t lis
t con
‑tr
olle
d pi
lot
stud
y
Uni
ted
Stat
esRe
crui
tmen
t fro
m th
e U
nive
rsity
of
Ariz
ona
Com
preh
en‑
sive
Can
cer
Cent
er;
loca
tion
of
clas
ses
not
spec
ified
. At
hom
e an
d in
‑cl
ass
sess
ions
oc
curr
ed
(unc
lear
if
clas
s is
in
‑per
son
or
onlin
e)
Feas
ibili
ty s
tudy
w
ith a
rand
‑om
ized
wai
t lis
t con
trol
tr
ial d
esig
n
Wom
en w
ith a
hi
stor
y of
bre
ast
canc
er tr
eate
d w
ith
adju
vant
sys
tem
ic
chem
othe
rapy
w
ithin
the
past
10
yea
rs (w
ith n
o cu
rren
t che
mo‑
ther
apy
othe
r th
an p
roph
ylac
tic
use
of a
sel
ectiv
e es
trog
en‑r
ecep
tor
mod
ulat
or);
ss:
n =
33
No
defin
ition
pr
ovid
edC
BCT
with
tr
aini
ng in
co
ncen
trat
ive
and
min
dful
‑ne
ss p
ract
ices
co
nsis
ting
of in
‑per
son
inst
ruct
or‑le
d gr
oup
clas
ses
in a
dditi
on to
at
‑hom
e pr
ac‑
tice
cons
istin
g of
gui
ded
med
itatio
ns
8 co
nsec
u‑tiv
e w
eeks
of
cla
sses
fo
llow
ed b
y a
"boo
ster
" cl
ass
at w
eek
12 (4
wee
ks
late
r)
Yes
1 m
onth
Sam
hkan
iyan
et
al.
2015
[31]
The
effec
tive‑
ness
of m
ind‑
fuln
ess‑
base
d co
gniti
ve
ther
apy
on
qual
ity o
f life
an
d lo
nelin
ess
of w
omen
w
ith H
IV
Iran
Not
spe
cifie
dQ
uasi
‑exp
eri‑
men
tal m
odel
w
ith p
rete
st–
post
test
and
ch
eck
team
Wom
en w
ho w
ere
hum
an im
mun
ode‑
ficie
ncy
viru
s (H
IV)
posi
tive
(n =
24)
—12
in c
ontr
ol a
nd
12 in
Min
dful
ness
‑Ba
sed
Cogn
itive
Th
erap
y (M
BCT)
The
diffe
renc
e be
twee
n cu
r‑re
nt a
nd id
eal
situ
atio
ns in
ac
hiev
ing
com
mun
ica‑
tion
with
ot
hers
and
so
ciet
y
MBC
T8
wee
ksN
oN
ot a
pplic
able
Blac
k et
al.
2014
[3
2]Ta
i chi
med
ita‑
tion
effec
ts
on n
ucle
ar
fact
or‑k
B si
gn‑
alin
g in
lone
ly
olde
r adu
lts:
A ra
ndom
ized
co
ntro
lled
tria
l
Uni
ted
Stat
esN
ot s
peci
fied
RCT
Lone
ly o
lder
adu
lts
(naï
ve to
tai c
hi
and
scor
ed 4
0 +
on
UC
LA L
onel
i‑ne
ss s
cale
); ss
: 26
rand
omiz
ed (s
plit
even
ly),
22 c
om‑
plet
ed p
ostin
ter‑
vent
ion
visi
t—10
in
Tai C
hi C
hih
(TCC
), 12
in s
tres
s an
d he
alth
edu
catio
n (S
HE)
No
defin
ition
pr
ovid
edG
roup
‑bas
ed
tai c
hi
med
itatio
n—m
edita
tion
tech
niqu
e,
TCC
con
sist
ed
of 2
0 gu
ided
m
edita
tive
mov
emen
ts
unde
r the
in
stru
ctio
n of
a c
ertifi
ed
teac
her
12 w
eeks
gr
oup‑
base
d pr
ogra
m
deliv
ered
w
eekl
y in
2‑h
se
ssio
ns
No
Not
app
licab
le
Page 12 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Cre
swel
l et a
l. 20
12 [9
]M
indf
ulne
ss‑
Base
d St
ress
Re
duct
ion
trai
ning
re
duce
s lo
ne‑
lines
s an
d pr
o‑in
flam
mat
ory
gene
exp
res‑
sion
in o
lder
ad
ults
: A s
mal
l ra
ndom
ized
co
ntro
lled
tria
l
Uni
ted
Stat
esN
ot s
peci
fied
RCT
40 h
ealth
y ol
der
adul
ts in
tere
sted
in
lear
ning
min
dful
‑ne
ss m
edita
tion
tech
niqu
es,
recr
uite
d vi
a ne
ws‑
pape
r adv
ertis
e‑m
ent
A s
tate
of s
ocia
l di
stre
ss th
at
aris
es w
hen
ther
e is
a
disc
repa
ncy
betw
een
one’
s de
sire
d an
d ac
tual
so
cial
rela
tion‑
ship
s
Min
dful
ness
‑Ba
sed
Stre
ss
Redu
ctio
n (M
BSR)
pro
‑gr
am, w
hich
is
a m
indf
ulne
ss
med
itatio
n in
terv
en‑
tion.
Dur
ing
each
gro
up
sess
ion,
an
inst
ruct
or le
d pa
rtic
ipan
ts
in g
uide
d m
indf
ulne
ss
med
itatio
n ex
erci
ses,
min
dful
yo
ga a
nd
stre
tchi
ng,
and
grou
p di
s‑cu
ssio
ns w
ith
the
inte
nt to
fo
ster
min
dful
aw
aren
ess
of o
ne’s
mom
ent‑
to‑m
omen
t ex
perie
nce.
Th
is is
don
e in
add
ition
to
a d
ay‑lo
ng
retr
eat a
nd
at‑h
ome
min
dful
ness
pr
actic
e
8 w
eeks
No
Not
app
licab
le
Page 13 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 2
(con
tinue
d)
Aut
hor a
nd
year
Title
Coun
try
Stud
y se
ttin
gst
udy
desi
gnPo
pula
tion
and
sam
ple
size
Lone
lines
s de
finiti
onM
edita
tion
type
Dur
atio
n of
m
edita
tion
Was
th
ere
a fo
llow
-up
If ye
s,
dura
tion
of
follo
w-u
p
Jaza
ieri
et a
l. 20
12 [3
3]A
rand
omiz
ed
tria
l of M
SBR
vers
us a
erob
ic
exer
cise
for
soci
al a
nxie
ty
diso
rder
Uni
ted
Stat
esEi
ght h
ealth
care
se
ttin
gs
thro
ugho
ut
the
San
Fran
cisc
o Ba
y A
rea
(spe
cif‑
ics
abou
t th
e ty
pes
of
heal
thca
re
sett
ings
are
no
t ava
ilabl
e)
RCT
Adu
lts w
ho m
et
DSM
‑IV c
riter
ia fo
r ge
nera
lized
soc
ial
anxi
ety
diso
rder
(n
= 5
6 in
inte
rven
‑tio
n gr
oup)
, n =
48
heal
thy
adul
ts in
co
ntro
l gro
up
No
defin
ition
pr
ovid
edSt
anda
rd M
BSR
prog
ram
, w
hich
com
‑pr
ises
eig
ht,
wee
kly
2.5‑
h gr
oup
clas
ses,
a 1‑
day
med
itatio
n re
trea
t, an
d da
ily h
ome
prac
tice.
Par
‑tic
ipan
ts w
ere
trai
ned
in
form
al m
edi‑
tatio
n pr
actic
e (i.
e., b
reat
h fo
cus,
body
sc
an, o
pen
mon
itorin
g),
brie
f inf
orm
al
prac
tice,
and
H
atha
yog
a.
Form
s to
m
onito
r dai
ly
med
itatio
n an
d yo
ga
prac
tice
wer
e co
llect
ed
each
wee
k (in
‑per
son)
8 w
eeks
Yes
3 m
onth
s
BEM
bra
in e
duca
tion-
base
d m
edita
tion,
CBC
T co
gniti
vely
bas
ed c
ompa
ssio
n tr
aini
ng, H
IV h
uman
imm
unod
efici
ency
viru
s, M
BCT
min
dful
ness
-bas
ed c
ogni
tive
ther
apy,
MBS
R m
indf
ulne
ss-b
ased
str
ess
redu
ctio
n tr
aini
ng,
MSC
min
dful
sel
f-co
mpa
ssio
n, R
CT ra
ndom
ized
con
trol
tria
l, SH
E st
ress
and
hea
lth e
duca
tion,
SS
sam
ple
size
, TCC
Tai
Chi
Chi
h
Page 14 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
Out
com
es a
nd fi
ndin
gs o
f elig
ible
stu
dies
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Broo
ker e
t al.
2020
[22]
To e
xam
ine
the
feas
i‑bi
lity
and
acce
ptab
il‑ity
of a
n ad
apta
tion
of th
e M
SC p
rogr
am
amon
g ad
ult c
ance
r pa
tient
s
Acc
epta
bilit
y (t
o cl
ini‑
cian
s) d
eter
min
ed b
y pr
opor
tion
of c
lini‑
cian
s ap
proa
ched
w
ho a
gree
d to
re
crui
t pat
ient
s to
th
e st
udy
Feas
ibili
ty o
f the
m
ail‑o
ut re
crui
t‑m
ent m
etho
d w
as
oper
atio
naliz
ed b
y th
e pe
rcen
tage
of
thes
e cl
inic
ians
who
fa
cilit
ated
a m
ail‑o
utA
ccep
tabi
lity
(to
invi
ted
patie
nts)
de
term
ined
by
the
perc
ent‑
age
of p
oten
tial
part
icip
ants
who
co
nsen
ted
to th
e pr
ogra
m, w
ith a
ta
rget
of 1
0–20
%A
ccep
tabi
lity
(am
ong
thos
e w
ho c
om‑
men
ced
the
pro‑
gram
) ass
esse
d by
re
tent
ion
rate
s, w
ith
70%
targ
et o
f at l
east
fo
ur g
roup
ses
sion
at
tend
ance
‑Acc
epta
bilit
y al
so
mea
sure
d us
ing
a M
SC p
rogr
am
eval
uatio
n fo
rm,
adap
ted
for c
ance
r co
ntex
t, in
clud
ed in
qu
estio
nnai
re a
fter
fin
al g
roup
ses
sion
To e
xam
ine
pre–
post
‑pr
ogra
m c
hang
es in
ps
ycho
soci
al w
ellb
e‑in
g: s
ympt
oms
of
depr
essi
on a
nd
stre
ss, f
ear o
f can
cer
recu
rren
ce, l
onel
i‑ne
ss, b
ody
imag
e,
self‑
com
pass
ion,
m
indf
ulne
ss
Dep
ress
ion
and
stre
ss s
ympt
oms
mea
sure
d by
21
‑item
Dep
ress
ion
Anx
iety
Str
ess
Scal
es
(DA
SS‑2
1)Fe
ar o
f can
cer r
ecur
‑re
nce
or p
rogr
es‑
sion
mea
sure
d by
9‑it
em F
ear o
f Ca
ncer
Rec
urre
nce
Inve
ntor
y‑Sh
ort
Form
(FC
RI‑S
F)Lo
nelin
ess
mea
sure
d by
20‑
item
UC
LA
Lone
lines
s Sc
ale
Vers
ion
3Bo
dy im
age
asse
ssed
us
ing
10‑it
em B
ody
App
reci
atio
n Sc
ale
(BA
S) V
ersi
on 2
Min
dful
ness
mea
sure
d us
ing
Cogn
itive
and
A
ffect
ive
Min
dful
‑ne
ss S
cale
‑Rev
ised
Posi
tive
and
nega
tive
face
ts o
f the
thre
e se
lf‑co
mpa
ssio
n co
mpo
nent
s m
eas‑
ured
usi
ng 2
6‑ite
m
Self‑
Com
pass
ion
Scal
e (S
CS)
Posi
tive:
Feas
ibili
ty a
nd a
ccep
t‑ab
ility
: 13
of 1
7 (7
6%) o
f app
roac
hed
clin
icia
ns a
gree
d to
recr
uit p
atie
nts;
19%
of c
onta
cted
pa
tient
s co
nsen
ted
to th
e pr
ogra
m—
in
tota
l, 32
par
ticip
ants
co
nsen
ted
to th
e pr
ogra
m, w
ith 3
0 co
mm
enci
ng it
and
27
com
plet
ing
itRe
sults
of I
nter
vent
ion:
Si
gnifi
cant
dec
reas
e in
lone
lines
s (m
ediu
m to
larg
e eff
ect)
, dep
ress
ion
(larg
e eff
ect)
, str
ess
(med
ium
to la
rge
effec
t), a
nd fe
ar
of c
ance
r rec
ur‑
renc
e (m
ediu
m
to la
rge
effec
t) in
in
terv
entio
n gr
oup.
Si
gnifi
cant
incr
ease
in
min
dful
ness
(lar
ge
effec
t)N
onsi
gnifi
cant
incr
ease
in
bod
y ap
prec
iatio
n (s
mal
l to
med
ium
eff
ect)
and
sel
f‑co
m‑
pass
ion
(med
ium
to
larg
e eff
ect)
Stud
y D
esig
n: S
tudy
di
d no
t inc
lude
a
cont
rol a
rm a
nd h
ad
a sm
all s
ampl
e si
ze,
mak
ing
it di
fficu
lt to
att
ribut
e pr
e‑ to
po
st‑in
terv
entio
n ch
ange
s to
inte
rven
‑tio
n. S
tudy
had
a
smal
l sam
ple
size
Prog
ram
Len
gth:
Sh
orte
ned
vers
ion
of th
e pr
ogra
m
was
del
iver
ed (1
4 vs
20
h) w
hich
may
ha
ve a
ccou
nted
for
smal
ler e
ffect
siz
esRe
crui
tmen
t Str
ateg
y:
Patie
nts
wer
e in
vite
d to
par
ticip
ate
by
trea
ting
clin
icia
ns,
whi
ch m
ay h
ave
elev
ated
per
ceiv
ed
acce
ptab
ility
co
mpa
red
to o
ther
ch
anne
ls
The
adap
tatio
n of
an
8‑w
eek
min
dful
ness
an
d se
lf‑co
mpa
ssio
n pr
ogra
m fo
r pat
ient
s w
ith n
on‑a
dvan
ced
canc
er d
iagn
osis
is
feas
ible
and
acc
ept‑
able
. Pre
limin
ary
findi
ngs
indi
cate
that
th
e in
terv
entio
n ha
s si
gnifi
cant
incr
ease
s in
psy
chos
ocia
l wel
l‑be
ing
and
lone
lines
s. H
owev
er, a
dditi
onal
st
udie
s w
ith a
con
trol
gr
oup
mus
t be
unde
rtak
en to
val
idat
e re
sults
Page 15 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Rodr
igue
z‑Ro
mer
o et
al.
2020
[23]
Lone
lines
s, so
cial
sup
‑po
rt, d
epre
ssio
n, a
nd
qual
ity o
f life
(phy
si‑
cal a
nd m
enta
l)
Perc
eive
d lo
nelin
ess
asse
ssed
by
the
UC
LA s
cale
Deg
ree
of a
uton
omy
mea
sure
d by
the
Bart
hel I
ndex
Deg
ree
of c
ogni
tive
impa
irmen
t ass
esse
d by
the
Pfei
ffer t
est
Dep
ress
ive
sym
ptom
s us
ing
the
Yesa
vage
ab
brev
iate
d qu
es‑
tionn
aire
Perc
eive
d so
cial
sup
‑po
rt e
valu
ated
by
the
Duk
e‑U
NC
‑11
Func
tiona
l Soc
ial
Supp
ort Q
uest
ion‑
naire
Perc
eive
d qu
ality
of
life
mea
sure
d by
th
e 12
‑Item
Sho
rt
Form
Hea
lth S
urve
y (S
F‑12
)G
roup
ses
sion
s as
sess
ed b
y in
terv
entio
n gr
oup
part
icip
ants
usi
ng a
sa
tisfa
ctio
n su
rvey
at
the
end
of th
e pr
ogra
mm
eSe
ssio
nal a
tten
danc
e co
llect
ed u
sing
a
wee
kly
atte
ndan
ce
reco
rd
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive:
Impr
ovem
ents
in a
ll m
easu
res
exce
pt fo
r th
e SF
‑12
(qua
l‑ity
of l
ife) p
hysi
cal
com
pone
nt‑S
igni
fican
t im
prov
e‑m
ent i
n de
gree
of
lone
lines
s w
ithin
the
inte
rven
tion
grou
p,
with
no
perc
eive
d lo
nelin
ess
show
n at
6 m
onth
s by
14
(48.
3%) p
artic
ipan
tsN
onsi
gnifi
cant
in
crea
se in
con
trol
gr
oup
patie
nts
with
se
vere
lone
lines
s at
6 m
onth
s (7
.7%
pr
eint
erve
ntio
n vs
. 19
.2%
pos
tinte
rven
‑tio
n)M
ean
impr
ovem
ent i
n de
gree
of l
onel
ines
s w
as 8
.63
poin
ts (9
5%
CI 1
.97–
15.3
0) h
ighe
r in
the
inte
rven
tion
grou
p in
com
paris
on
to th
e co
ntro
l gro
up
(p =
0.0
12)
Smal
l sam
ple
size
: O
f the
80
refe
rred
pa
tient
s, 25
wer
e ex
clud
ed s
ince
6
wer
e un
avai
l‑ab
le th
roug
hout
th
e st
udy,
6 d
idn’
t ex
perie
nce
lone
li‑ne
ss, 6
did
n’t a
tten
d se
ssio
ns d
ue to
ca
ring
for a
rela
tive
24 h
a d
ay, 6
did
n’t
have
eno
ugh
time,
an
d 1
refu
sed
to
part
icip
ate.
It is
har
d to
recr
uit l
onel
y pe
o‑pl
e, a
s se
en th
roug
h th
e sm
all s
ampl
e si
ze, w
hich
sug
gest
s th
at th
e co
mm
unity
in
terv
entio
n re
ache
d pr
imar
ily p
eopl
e w
ith
mod
erat
e lo
neli‑
ness
; not
thos
e w
ith
seve
re lo
nelin
ess,
who
mig
ht b
enefi
t fro
m a
mor
e pe
rson
‑al
ised
app
roac
hSt
udy
desi
gn: D
id n
ot
allo
w fo
r mea
sure
‑m
ent o
f the
inte
r‑ve
ntio
n be
nefit
s ov
er
time
due
to a
lack
of
follo
w‑u
p on
ce
the
inte
rven
tion
was
co
mpl
ete
Aft
er p
artic
ipat
ing
in a
co
mm
unity
inte
rven
‑tio
n pr
omot
ing
soci
ali‑
satio
n, a
lmos
t hal
f of
the
lone
ly o
lder
per
‑so
ns s
topp
ed fe
elin
g lo
nely
and
thei
r hea
lth
stat
us im
prov
ed. D
ur‑
ing
this
sam
e pe
riod
of ti
me,
con
trol
s w
ith
a si
mila
r bas
elin
e sh
owed
no
chan
ge
in th
eir p
erce
ptio
n of
lone
lines
s or
oth
er
heal
th v
aria
bles
. The
se
resu
lts a
re s
imila
r to
the
findi
ngs
in o
ther
st
udie
s, ho
wev
er, a
sm
alle
r dec
reas
e in
lo
nelin
ess
is s
een
in
stud
ies
of in
divi
dual
in
terv
entio
ns
Page 16 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Lee
et a
l. 20
19 [2
4]W
heth
er B
EM a
ffect
s th
e co
nditi
ons
of
patie
nts
with
hyp
er‑
tens
ion
and/
or ty
pe
2 di
abet
es c
ompa
red
with
hea
lth e
duca
‑tio
n cl
asse
s (M
enta
l/ph
ysic
al h
ealth
and
w
ellb
eing
: rel
axat
ion,
fo
cus,
happ
ines
s, co
nfide
nce,
redu
c‑tio
n in
ang
er, l
onel
i‑ne
ss)
Bloo
d co
llect
ion,
fol‑
low
ed b
y m
easu
re‑
men
t of s
erum
gl
utam
ic‑o
xalo
acet
ic
tran
sam
inas
e, s
erum
gl
utam
ic p
yruv
ic
tran
sam
inas
e,
γ‑gl
utam
yl tr
ans‑
fera
se, c
reat
inin
e,
high
‑den
sity
lipo
pro‑
tein
cho
lest
erol
, and
lo
w‑d
ensi
ty li
popr
o‑te
in (L
DL)
cho
lest
erol
Ribo
nucl
eic
acid
(R
NA
) ext
ract
ion,
co
mpl
emen
tary
de
oxyr
ibon
ucle
ic
acid
syn
thes
is a
nd
reve
rse
tran
scrip
tion
poly
mer
ase
chai
n re
actio
n of
infla
m‑
mat
ory
gene
sSe
lf‑re
port
ed q
ues‑
tionn
aire
s of
men
tal
and
phys
ical
hea
lth
of 2
0 ite
ms
with
a
5‑po
int L
iker
t‑ty
pe s
cale
for e
ach
resp
onse
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive:
Inte
rven
tion
(BEM
) gr
oup
show
ed
sign
ifica
nt d
ecre
ases
in
LD
L ch
oles
tero
l po
st‑in
terv
entio
n,
whi
le c
ontr
ol g
roup
di
d no
t. In
terv
entio
n gr
oup
also
had
sig
‑ni
fican
t red
uctio
ns in
ex
pres
sion
of i
nflam
‑m
ator
y ge
nes
Men
tal a
nd P
hysi
cal
Hea
lth: P
ost‑
inte
rven
tion
self‑
repo
rt s
core
s fo
r the
inte
rven
tion
grou
p sh
owca
se
sign
ifica
nt in
crea
ses
in fo
cus,
confi
denc
e,
rela
xatio
n an
d ha
p‑pi
ness
, alo
ng w
ith
sign
ifica
nt d
ecre
ases
in
fatig
ue, a
nger
and
lo
nelin
ess
Ther
e w
ere
no im
por‑
tant
adv
erse
eve
nts
or s
ide‑
effec
ts b
y BE
M in
terv
entio
n
Stud
y D
esig
n: R
ela‑
tivel
y sm
all s
ampl
e si
ze (f
ollo
w‑u
p w
ith
a la
rger
sam
ple
need
ed to
val
idat
e fin
ding
s). I
nter
ven‑
tion
(BEM
) inc
lude
d bo
th s
tatic
and
dy
nam
ic e
lem
ents
m
akin
g it
diffi
cult
to k
now
whi
ch e
le‑
men
ts c
ontr
ibut
ed
to w
hich
resu
lts.
Mor
e m
easu
rem
ents
re
quire
d su
ch a
s he
mog
lobi
n A
1c a
nd
body
mas
s in
dex
(BM
I)O
ther
Fac
tors
Res
pon‑
sibl
e fo
r Effe
cts:
Med
icat
ion
type
s w
ere
not c
ontr
olle
d fo
r, th
eref
ore
som
e of
the
med
icat
ion
take
n by
par
ticip
ants
m
ay h
ave
impa
cted
re
sults
The
resu
lts o
f the
pi
lot‑
rand
omiz
ed
cont
rolle
d tr
ail
show
case
that
a B
EM
inte
rven
tion
redu
ces
LDL
chol
este
rol a
nd
infla
mm
ator
y ge
ne
expr
essi
on, i
n ad
ditio
n to
impr
ovin
g m
enta
l an
d ph
ysic
al h
ealth
in
pat
ient
s w
ith ty
pe
2 di
abet
es/h
yper
ten‑
sion
, com
pare
d to
he
alth
edu
catio
n.
Sinc
e bo
th ty
pe 2
dia
‑be
tes
and
hype
rten
‑si
on a
re c
hron
ic c
on‑
ditio
ns, p
ositi
ve e
ffect
s fro
m n
on‑in
vasi
ve
inte
rven
tions
suc
h as
BE
M a
re s
igni
fican
t for
lo
ng‑t
erm
com
ple‑
men
tary
car
e
Page 17 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Lind
say
et a
l. 20
19 [2
5]A
sses
sing
lone
lines
s an
d so
cial
isol
atio
n/so
cial
inte
ract
ion
in
part
icip
ants
’ nat
ural
en
viro
nmen
ts, a
s w
ell a
s gl
obal
retr
o‑sp
ectiv
e m
easu
res
of lo
nelin
ess
and
soci
al s
uppo
rt. S
ocia
l Pr
oces
ses
(sub
jec‑
tive
perc
eptio
n of
lo
nelin
ess,
obje
ctiv
e nu
mbe
r of s
ocia
l in
tera
ctio
n an
d pa
rtne
rs)
Soci
al p
roce
sses
mea
s‑ur
ed b
y Ec
olog
ical
M
omen
tary
Ass
ess‑
men
t, ca
rrie
d ou
t 4
quas
i‑ran
dom
tim
es
a da
y, a
nd E
nd‑o
f‑D
ay S
urve
ysRe
tros
pect
ive
lone
li‑ne
ss m
easu
red
by
UC
LA L
onel
ines
s Sc
ale
Retr
ospe
ctiv
e so
cial
is
olat
ion
mea
sure
d by
Soc
ial N
etw
ork
Inde
xRe
tros
pect
ive
soci
al
supp
ort m
easu
red
by In
terp
erso
nal
Supp
ort E
valu
atio
n Li
stRe
actio
ns to
soc
ial
inte
ract
ions
wer
e m
easu
red
usin
g a
subs
et o
f Eco
logi
cal
Mom
enta
ry S
urve
y
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive
Out
com
e fo
r So
me
Inte
rven
tions
:Pa
tient
s un
derg
oing
m
onito
r and
acc
ept‑
ance
min
dful
ness
m
edita
tion
trai
ning
sh
owed
sig
nific
ant
decr
ease
s in
lone
li‑ne
ss a
nd s
igni
fican
t in
crea
ses
in s
ocia
l in
tera
ctio
ns p
re‑ t
o po
st‑in
terv
entio
n.
In c
ontr
ast,
patie
nts
in th
e m
onito
r onl
y or
con
trol
gro
up d
id
not s
how
case
any
si
gnifi
cant
diff
er‑
ence
s in
lone
lines
s an
d so
cial
inte
rac‑
tions
pre
‑ to
post
‑in
terv
entio
nO
vera
ll, m
onito
r and
ac
cept
ance
trai
ning
re
duce
d da
ily‑li
fe
lone
lines
s by
22%
, an
d in
crea
sed
soci
al
inte
ract
ions
by
2 m
ore
inte
ract
ions
pe
r day
and
one
m
ore
pers
on p
er d
ay
com
pare
d to
mon
i‑to
r onl
y or
con
trol
tr
aini
ng
Stud
y D
esig
n: S
am‑
plin
g (R
ecru
ited
a sa
mpl
e of
str
esse
d co
mm
unity
adu
lts
rath
er th
an s
pe‑
cific
ally
targ
etin
g so
cial
ly is
olat
ed
indi
vidu
als)
and
fo
llow
‑up
(no
follo
w‑
up in
clud
ed in
stu
dy)
Furt
her r
esea
rch
is
need
ed to
test
w
heth
er s
mar
t‑ph
one‑
base
d m
ind‑
fuln
ess
med
itatio
n tr
aini
ng c
an re
duce
lo
nelin
ess
with
in
lone
ly p
opul
atio
nFu
rthe
r res
earc
h is
als
o ne
eded
to id
entif
y w
heth
er m
indf
ul‑
ness
trai
ning
hel
ps
stre
ngth
en c
urre
nt
rela
tions
hips
or a
ids
in th
e fo
rmat
ion
of
new
rela
tions
hips
This
2‑w
eek
tria
l pro
‑vi
des
evid
ence
that
in
divi
dual
ly d
eliv
ered
sm
artp
hone
‑bas
ed
min
dful
ness
trai
ning
ca
n re
duce
lone
li‑ne
ss a
nd in
crea
se
soci
al c
onta
ct in
dai
ly
life.
Impo
rtan
tly, t
he
diffe
renc
es b
etw
een
inte
rven
tion
grou
ps
show
case
d th
e im
por‑
tanc
e of
dev
elop
ing
an a
ccep
ting
attit
ude
tow
ards
pre
sent
ex
perie
nces
in o
rder
to
dec
reas
e lo
nelin
ess
and
impr
ove
soci
al
cont
act
Page 18 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Pand
ya 2
019
[26]
Lone
lines
s, W
ell‑B
eing
, Li
fe S
atis
fact
ion,
Con
‑te
ntm
ent w
ith L
ife
6‑Ite
m d
e Jo
ng
Gie
rvel
d Lo
nelin
ess
Scal
eW
arw
ick‑
Edin
burg
h M
enta
l Wel
lbei
ng
Scal
e5‑
Item
Sat
isfa
ctio
n w
ith L
ife S
cale
(S
WLS
)Co
nten
tmen
t with
Life
A
sses
smen
t Sca
le
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive:
Pre‑
Inte
rven
tion:
The
re
wer
e no
sig
nific
ant
diffe
renc
es in
psy
‑ch
osoc
ial m
easu
res
with
in th
e in
terv
en‑
tion
and
cont
rol
grou
p at
bas
elin
ePo
st‑In
terv
entio
n: N
o si
gnifi
cant
incr
ease
s in
mea
sure
s fo
r co
ntro
l gro
up.
In c
ontr
ast,
the
inte
rven
tion
grou
p sh
owed
a s
ig‑
nific
ant d
ecre
ase
in
lone
lines
s, si
gnifi
cant
in
crea
se in
men
tal
wel
l‑bei
ng, s
atis
fac‑
tion
with
life
, and
co
nten
tmen
t with
lif
e. F
urth
erm
ore,
all
post
‑inte
rven
tion
outc
ome
mea
sure
s fo
r the
inve
ntio
n gr
oup
wer
e hi
gher
th
an fo
r the
con
trol
gr
oup
Stud
y D
esig
n: D
ata
was
onl
y ga
ther
ed
at 2
spe
cific
tim
e po
ints
, whi
ch d
oes
not a
ccou
nt fo
r in
terim
cha
nges
. No
qual
itativ
e da
ta w
as
colle
cted
to s
tudy
pe
rcep
tions
of i
nter
‑ve
ntio
n. S
elf‑p
ract
ice
was
an
impo
rtan
t pr
edic
tor f
or s
ucce
ss,
but v
aria
nces
in
cond
ition
s fo
r sel
f‑pr
actic
e w
ere
not
trac
ked
or c
ontr
olle
dSa
mpl
ing
and
Stud
y Po
pula
tion:
Stu
dy
popu
latio
n ha
d a
lot o
f het
erog
enei
ty,
mos
tly c
ompr
omis
‑in
g m
iddl
e‑cl
ass
mar
ried
Hin
du m
en
A c
usto
miz
ed m
edita
‑tio
n pr
ogra
m c
an
sign
ifica
ntly
alle
viat
e lo
nelin
ess
in o
lder
ad
ults
. It m
ay b
e cu
stom
ized
and
re
fined
for d
iffer
ent
dem
ogra
phic
s su
ch a
s w
omen
, upp
er c
lass
in
divi
dual
s, si
ngle
vs
mar
ried,
livi
ng a
lone
vs
coh
abiti
ng w
ith
fam
ily, B
uddh
ists
, and
th
ose
with
con
geni
tal
chro
nic
ailm
ents
. Lo
nelin
ess‑
miti
gatio
n is
thro
ugh
build
ing
olde
r par
ticip
ants
’ in
ner r
esou
rces
rath
er
than
net
wor
ks a
nd
soci
al s
kills
. Pro
gram
im
pact
is d
epen
dent
on
regu
lar a
tten
danc
e an
d ho
me
prac
tice
Page 19 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Mas
caro
et a
l. 20
18
[27]
(1) i
nves
tigat
e th
e fe
asib
ility
of C
BCT
for
seco
nd‑y
ear m
edic
al
stud
ents
, and
(2)
test
whe
ther
CBC
T de
crea
ses
depr
es‑
sion
, enh
ance
s co
mpa
ssio
n, a
nd
impr
oves
dai
ly fu
nc‑
tioni
ng in
med
ical
st
uden
ts. (
3) w
ho
bene
fited
mos
t fro
m
com
pass
ion
med
ita‑
tion
by te
stin
g th
e hy
poth
esis
that
C
BCT
wou
ld h
ave
the
grea
test
impa
ct
on c
ompa
ssio
n am
ong
thos
e su
ffer‑
ing
from
dep
ress
ion,
st
ress
, and
anx
iety
Dig
ital o
r pap
er s
elf‑
repo
rt q
uest
ion‑
naire
s pr
e an
d po
st
inte
rven
tion
Inte
rper
sona
l hea
lth
mea
sure
d us
ing
Com
pass
iona
te L
ove
for H
uman
ity S
cale
UC
LA L
onel
ines
s Sc
ale
(R‑U
CLA
)Sl
eep
qual
ity a
sses
sed
usin
g Pi
ttsb
urgh
Sl
eep
Scal
eQ
uant
ity a
nd fr
e‑qu
ency
of s
ubst
ance
us
e su
ch a
s to
bacc
o,
mar
ijuan
a, a
lcoh
ol,
or p
resc
riptio
n dr
ugs,
mea
sure
d us
ing
Subs
tanc
e U
se
Inve
ntor
yN
egat
ive
emot
ions
m
easu
red
usin
g D
ASS
Freq
uenc
y of
phy
sica
l an
d ae
robi
c ex
erci
se
over
the
past
mon
th
mea
sure
d by
ask
ing
two
ques
tions
as
part
of a
sses
smen
t
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive:
Indi
vidu
als r
ando
miz
ed
to C
BCT
inte
rven
‑tio
n re
port
ed
sign
ifica
nt d
ecre
ase
in d
epre
ssio
n an
d lo
nelin
ess,
alon
g w
ith a
n in
crea
se in
co
mpa
ssio
n an
d le
ss e
xerc
ise
post
‑in
terv
entio
n. T
here
w
ere
no s
igni
fican
t ch
ange
s in
the
wai
t‑lis
t con
trol
gro
up
post
‑inte
rven
tion
Furt
herm
ore,
ther
e w
as
a si
gnifi
cant
mai
n eff
ect o
f tim
e in
the
CBC
T in
terv
entio
n gr
oup
for i
ncre
ases
in
com
pass
iona
te
love
and
sle
ep, a
nd
decr
ease
s in
lone
li‑ne
ss, d
epre
ssio
n an
d ex
erci
se
Sam
ple
size
: Sm
all
Oth
er n
on‑s
peci
fic
fact
ors
may
hav
e in
fluen
ced
outc
omes
Stud
y do
es n
ot
prov
ide
sign
ifica
nt
insi
ght i
nto
the
com
‑pl
ex n
atur
e of
soc
io‑
cogn
itive
cha
nges
th
at m
ay re
sult
from
C
BCT
or h
ow th
ey
may
alte
r phy
sici
an
com
pete
nce
or
patie
nt o
utco
mes
The
stud
y’s
findi
ngs
indi
cate
that
CBC
T m
ay b
e be
nefic
ial f
or
enha
ncin
g co
mpa
s‑si
on a
nd re
duci
ng
depr
essi
on a
nd
lone
lines
s fo
r med
ical
st
uden
ts. F
urth
er
stud
ies
are
need
ed to
st
udy
mec
hani
sms
of
the
CBC
T eff
ect,
alon
g w
ith it
s lo
ng‑t
erm
eff
ects
and
impa
cts
of
patie
nt o
utco
mes
Page 20 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Kok
et a
l. 20
17 [2
8]Se
lf‑di
sclo
sure
and
so
cial
clo
sene
ssEn
gage
men
t Mea
sure
s (c
ompl
ianc
e, li
k‑in
g, m
otiv
atio
n to
pr
actic
e)O
utco
me
Mea
sure
s (C
lose
ness
of d
yadi
c pa
rtne
r, se
lf‑di
sclo
‑su
re)
Com
plia
nce
mea
sure
d th
roug
h ra
nked
sca
le
repo
rtin
g of
mot
iva‑
tion
and
likin
gC
lose
ness
mea
sure
d w
ith In
clus
ion
of
Oth
er in
the
Self
Scal
eSe
lf‑di
sclo
sure
usi
ng
Rank
ed S
cale
for
Self‑
Dis
clos
ure
Ratin
g
Vale
nce
and
arou
sal
Vale
nce
and
arou
sal
asse
ssed
bef
ore
and
afte
r all
sess
ions
, as
sess
ing
affec
t with
sc
ales
usi
ng ra
nges
of
0 to
8
Posi
tive:
All
part
icip
ants
pr
actic
ed b
reat
hing
m
edita
tion
and
body
sc
ans
(pre
senc
e m
odul
es),
follo
wed
by
dya
dic
prac
tice
(affe
ct m
odul
e an
d pe
rspe
ctiv
e m
odul
e).
Com
plia
nce
was
si
mila
r acr
oss
all
mod
ules
, whi
le m
oti‑
vatio
n w
as h
ighe
r fo
r the
med
itatio
n m
odul
esSo
cial
clo
sene
ss
show
ed s
igni
fican
t im
prov
emen
ts d
ur‑
ing
a se
ssio
n fo
r the
aff
ect d
yads
and
sig
‑ni
fican
t inc
reas
e ov
er
time
for t
he a
ffect
dy
ad. S
elf‑
disc
losu
re
incr
ease
d ov
er ti
me
for t
he a
ffect
dya
d an
d th
e pe
rspe
c‑tiv
e dy
ad, w
ith th
e pe
rspe
ctiv
e dy
ad
show
casi
ng a
gre
ater
ra
te o
f inc
reas
e (b
oth
sign
ifica
nt re
sults
)
Stud
y D
esig
n: T
rial o
f co
ntem
plat
ive
dyad
s w
as e
mbe
dded
w
ith a
larg
er m
enta
l tr
aini
ng s
tudy
; the
re‑
fore
, the
effe
cts
of
cont
empl
ativ
e dy
ads
on s
ocia
l clo
sene
ss
and
self‑
disc
losu
re
need
s to
be
stud
ied
inde
pend
ently
Stud
y Po
pula
tion:
In
clud
ed o
nly
heal
th
adul
ts; f
urth
er
rese
arch
with
pop
u‑la
tions
at g
reat
er
risk
of s
uffer
ing
from
lo
nelin
ess,
such
as
olde
r adu
lts o
r adu
lts
with
mal
adap
tive
soci
al c
ogni
tions
, is
need
ed
In th
is tr
ial,
2 ty
pes
of c
onte
mpl
ativ
e dy
adic
exe
rcis
es
prac
ticed
ove
r 6
mon
ths
incr
ease
d so
cial
clo
sene
ss a
nd
self‑
disc
losu
re a
mon
g pa
rtic
ipan
ts. P
rovi
des
evid
ence
for n
ew
type
of i
nter
vent
ion
targ
etin
g so
cial
con
‑ne
ctio
n in
indi
vidu
als
who
may
suff
er fr
om
lone
lines
s
Page 21 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Tkat
ch e
t al.
2017
[29]
To d
eter
min
e if
this
inte
rven
tion
coul
d be
a fe
asib
le
appr
oach
for t
his
popu
latio
n (c
omm
u‑ni
ty‑d
wel
ling
olde
r ad
ult c
areg
iver
s).
Feas
ibili
ty w
as
initi
ally
ass
esse
d by
th
e ab
ility
to a
ttra
ct
part
icip
ants
and
su
stai
n en
gage
men
t in
the
inte
rven
tion
Att
enda
nce
of th
e w
eekl
y (o
nlin
e an
d in
‑per
son)
mod
ules
w
as re
cord
ed
Impa
ct o
f the
inte
r‑ve
ntio
n on
car
egiv
er
burd
en, q
ualit
y of
lif
e (m
enta
l and
ph
ysic
al w
ell‑b
eing
), an
d ps
ycho
logi
cal
wel
l‑bei
ng m
eas‑
ures
, inc
ludi
ng s
tres
s, lo
nelin
ess,
anxi
ety,
an
d so
cial
sup
port
Base
line
and
post
‑tre
atm
ent
surv
eys
mea
sure
d th
e im
pact
of
the
inte
rven
tion,
su
ch a
s ca
regi
ver
burd
en, q
ualit
y of
lif
e, p
sych
olog
ical
w
ell‑b
eing
mea
sure
s su
ch a
s lo
nelin
ess,
stre
ss, a
nxie
ty, s
ocia
l su
ppor
tCa
regi
ver b
urde
n m
easu
red
by Z
arit
Shor
t Bur
den
Inte
rvie
w12
‑item
Vet
eran
’s Ra
nd4‑
item
Per
ceiv
ed
Stre
ss S
cale
7‑ite
m G
ener
aliz
ed
Anx
iety
Dis
orde
r Tes
t3‑
item
UC
LA L
onel
i‑ne
ss S
cale
12‑it
em In
terp
erso
nal
Supp
ort E
valu
atio
n Li
st
Posi
tive:
Post
‑inte
rven
tion,
pa
rtic
ipan
ts h
ad
sign
ifica
nt d
ecre
ases
in
car
egiv
er b
urde
n,
stre
ss, l
onel
ines
s, an
d an
xiet
y, a
nd
sign
ifica
nt in
crea
ses
in m
enta
l hea
lthH
ighe
r lev
els
of s
essi
on
atte
ndan
ce w
as
sign
ifica
ntly
ass
oci‑
ated
with
pos
itive
ch
ange
s in
per
ceiv
ed
soci
al s
uppo
rt a
nd
the
men
tal c
ompo
‑ne
nt s
core
, alo
ng
with
sig
nific
ant
decr
ease
s in
str
ess
and
anxi
ety
Stud
y D
esig
n: N
o co
n‑tr
ol g
roup
and
sm
all
sam
ple
size
Stud
y Po
pula
tion:
Pa
rtic
ipan
ts w
ere
recr
uite
d fro
m a
n ex
istin
g ca
regi
ver
supp
ort g
roup
and
th
eref
ore,
mig
ht
have
a g
reat
er n
eed
for s
uppo
rt a
nd a
w
illin
gnes
s to
par
‑tic
ipat
e, d
ecre
asin
g ge
nera
lizab
ility
to a
ll ca
regi
vers
This
pilo
t stu
dy p
rovi
des
evid
ence
that
onl
ine
min
dful
ness
med
ita‑
tion
prog
ram
s ha
ve
the
pote
ntia
l to
sign
ifica
ntly
redu
ce
care
give
r bur
den,
al
ong
with
impr
ov‑
ing
men
tal h
ealth
fo
r old
er c
areg
iver
s. Fu
ture
stu
dies
cou
ld
expa
nd o
n re
sults
by
test
ing
with
a la
rger
sa
mpl
e si
ze a
nd
long
itudi
nal c
ohor
ts
or ta
rget
ing
care
give
rs
of o
lder
adu
lts w
ith
spec
ial n
eeds
or
youn
g ch
ildre
n
Page 22 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Dod
ds e
t al.
2015
[30]
The
feas
ibili
ty o
f a
med
itatio
n‑ba
sed
prog
ram
(CBC
T)
with
bre
ast c
ance
r su
rviv
ors
trea
ted
with
sys
tem
ic a
dju‑
vant
che
mot
hera
py
with
in p
ast 1
0 ye
ars
Recr
uitm
ent r
ate
Scre
enin
g an
d en
roll‑
men
t rat
eC
lass
att
enda
nce
Adh
eren
ceRe
tent
ion
Part
icip
ant s
atis
fact
ion
and
inte
rest
The
impa
ct o
f CBC
T on
beh
avio
ural
end
‑po
ints
(Per
cept
ions
of
Lon
elin
ess
and
Soci
al C
onne
cted
‑ne
ss, P
erce
ived
St
ress
, Dep
ress
ion,
Ps
ycho
logi
cal D
is‑
tres
s an
d Fu
nctio
n‑in
g Im
pairm
ents
lin
ked
to fe
ar o
f ca
ncer
recu
rren
ce,
Intr
usiv
e Th
ough
ts,
Avo
idan
ce a
nd
Hyp
erar
ousa
l, Pa
in
and
Vita
lity,
Glo
bal
Att
entio
n, A
war
e‑ne
ss, P
rese
nt F
ocus
an
d A
ccep
tanc
e,
Gra
titud
e, S
atis
fac‑
tion)
Diu
rnal
rhyt
hm o
f co
rtis
ol (a
str
ess‑
rela
ted
endo
crin
e bi
omar
ker)
Impa
ct o
f hom
e pr
ac‑
tice
on o
utco
mes
(A
dher
ence
to C
BCT
Prot
ocol
)
Saliv
ary
cort
isol
co
llect
ion
thro
ugh
at‑h
ome
colle
ctio
n ki
ts4‑
item
Per
ceiv
ed
Stre
ss S
cale
(PSS
‑4)
Brie
f Cen
ter f
or
Epid
emio
logi
c St
ud‑
ies—
Dep
ress
ion
ques
tionn
aire
Five
sub
scal
es o
f the
FC
RIIm
pact
of E
vent
s Sc
ale—
Revi
sed
R‑U
CLA
Ver
sion
3M
edic
al O
utco
mes
St
udy
SF‑1
2Co
gniti
ve a
nd A
ffec‑
tive
Min
dful
ness
Sc
ale—
Revi
sed
Gra
titud
e Q
uest
ion‑
naire
—6,
par
ticip
ant
satis
fact
ion
mea
s‑ur
ed b
y tw
o ite
ms
Posi
tive:
Pos
itive
but
no
n‑si
gnifi
cant
fin
ding
s in
rela
tion
to
lone
lines
sFe
asib
ility
and
Acc
ept‑
ance
: Att
enda
nce
and
part
icip
ant
satis
fact
ion
met
the
pre‑
defin
ed c
riter
ia,
whi
le re
tent
ion,
ho
me
med
itatio
n pr
actic
e da
ys a
nd
recr
uitm
ent r
ate
wer
e sl
ight
ly u
nder
go
als
Beha
viou
ral a
nd P
sy‑
chos
ocia
l Out
com
es:
Sign
ifica
nt d
ecre
ases
in
dep
ress
ive
sym
p‑to
ms,
func
tiona
l im
pairm
ents
from
fe
ar o
f can
cer r
ecur
‑re
nce,
avo
idan
ce
wer
e ob
serv
ed p
re‑
to p
ost‑
inte
rven
tion,
in
add
ition
to a
si
gnifi
cant
incr
ease
in
min
dful
pre
senc
eLo
nelin
ess:
Non
sig‑
nific
ant d
ecre
ase
in
lone
lines
s po
st‑
inte
rven
tion
and
at
1‑m
onth
follo
w‑u
pCo
rtis
ol: N
o eff
ect o
f C
BCT
was
obs
erve
d on
any
mea
sure
of
cor
tisol
(inc
lud‑
ing
diur
nal c
ortis
ol
rhyt
hm)
Recr
uitm
ent R
ate:
Lo
wer
than
pla
nned
, w
ith a
bia
s to
war
ds
part
icip
ants
with
hi
gher
. soc
ioec
o‑no
mic
sta
tus
Pote
ntia
l Bia
s: Po
tent
ial
posi
tive
impa
ct
of s
elf‑r
epor
ting
prob
lem
s co
mm
only
ex
perie
nced
dur
ing
surv
ivor
ship
Dat
a Co
llect
ion:
3
Part
icip
ants
did
not
re
turn
pra
ctic
e lo
g da
ta a
t fol
low
‑up
perio
dEff
ects
of I
nter
vent
ion:
Po
ssib
le c
eilin
g eff
ect
with
par
ticip
ants
en
gagi
ng in
at‑
hom
e m
edita
tion
prac
tice
to th
e po
int w
here
a
posi
tive
corr
elat
ion
is
less
like
ly to
be
seen
With
in th
e lim
its o
f a
pilo
t fea
sibi
lity
stud
y,
resu
lts s
ugge
st th
at
CBC
T is
a fe
asib
le a
nd
high
ly s
atis
fact
ory
inte
rven
tion
pote
n‑tia
lly b
enefi
cial
to th
e ps
ycho
logi
cal w
ell‑
bein
g of
bre
ast c
ance
r su
rviv
ors.
How
ever
, m
ore
com
preh
ensi
ve
tria
ls a
re n
eede
d to
pr
ovid
e sy
stem
atic
ev
iden
ce
Page 23 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Sam
hkan
iyan
et a
l. 20
15 [3
1]Th
e pe
rfor
man
ce o
f m
indf
ulne
ss a
ccor
d‑in
g to
the
cogn
itive
ap
proa
ch o
n th
e qu
ality
of l
ife a
nd
lone
lines
s of
wom
en
with
HIV
Qua
lity
of li
fe s
urve
y fro
m W
HO
and
re
vise
d U
CLA
to
both
gro
ups
pre
and
post
inte
rven
tion
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive:
MBC
T re
sulte
d in
in
crea
ses
in m
ean
qual
ity o
f life
and
no
n‑si
gnifi
cant
de
crea
ses
in
lone
lines
s (w
hen
com
parin
g pr
e‑ a
nd
post
‑inte
rven
tion
scor
es w
ithin
the
inte
rven
tion
grou
p on
ly, a
nd b
etw
een
inte
rven
tion
and
cont
rol g
roup
)
Sam
ple
Size
: Sm
all
sam
ple
size
, whi
ch
coul
d m
inim
ize
gene
raliz
abili
ty a
nd
sign
ifica
nce
of re
sults
No
sim
ilar s
tudi
es in
Ira
n to
val
idat
e/co
m‑
pare
con
clus
ions
to
This
stu
dy p
rovi
des
evid
ence
that
gro
up
base
d M
BCT
is e
ffec‑
tive
in re
duci
ng lo
neli‑
ness
and
incr
easi
ng
the
qual
ity o
f life
in
wom
en w
ith H
IV
Blac
k et
al.
2014
[32]
Affe
ct o
f TCC
on
psy‑
chol
ogic
str
ess
and
NF‑
κB le
vels
in lo
nely
ol
der a
dults
, as
com
‑pa
red
to th
ose
who
re
ceiv
e a
stre
ss a
nd
heal
th e
duca
tion
(SH
E) in
terv
entio
n
14‑It
em P
SSBl
ood
sam
ple
colle
c‑tio
n an
d m
easu
re‑
men
t of s
erum
nu
clea
r fac
tor
(NF)
‑kB
Not
ava
ilabl
eN
ot a
pplic
able
Unc
lear
/Pos
itive
Fin
d‑in
gs:
In th
e he
alth
edu
ca‑
tion
cont
rol g
roup
, ps
ycho
logi
cal
stre
ss le
vels
wer
e un
chan
ged,
whi
le
nucl
ear l
evel
s of
ac
tivat
ed N
F‑κB
si
gnifi
cant
ly in
crea
se
post
‑inte
rven
tion
In th
e Ta
i Chi
inte
rven
‑tio
n gr
oup,
leve
ls
of p
sych
olog
ical
st
ress
sig
nifi‑
cant
ly d
ecre
ased
, w
hile
NF‑
κB
leve
ls re
mai
ned
unch
ange
d po
st‑
inte
rven
tion
Stud
y Po
pula
tion:
Sm
all s
ampl
e si
ze
cons
istin
g pr
edom
i‑na
ntly
of w
omen
, lim
iting
gen
eral
iz‑
abili
ty o
f res
ults
Lack
of M
easu
rem
ents
: N
F‑κB
leve
ls w
ere
only
mea
sure
d in
pe
riphe
ral b
lood
m
onon
ucle
ar c
ells
(P
BMC
s); t
here
‑fo
re, o
bser
ved
chan
ges
may
be
due
to c
hang
es in
ly
mph
ocyt
e su
bset
di
strib
utio
n
TCC
sig
nific
antly
re
duce
d le
vels
of
psyc
holo
gica
l str
ess
com
pare
d to
the
cont
rol g
roup
, whi
le
atte
nuat
ing
the
rise
of N
F‑κB
act
ivat
ion
in
lone
ly o
lder
adu
lts
Page 24 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Cre
swel
l et a
l. 20
12 [9
]Eff
ects
of M
BSR
on
lone
lines
s an
d lo
nelin
ess‑
rela
ted
infla
mm
ator
y ge
nes
such
as
NF‑
kB
Perc
eive
d lo
nelin
ess
asse
ssed
by
the
UC
LA s
cale
, rev
ised
(U
CLA
‑R) a
t bas
elin
e an
d po
st‑t
reat
men
tBl
ood
sam
ple
col‑
lect
ion
and
RNA
ex
trac
ted
from
PB
MC
sM
indf
ulne
ss m
easu
red
usin
g 39
‑item
Ken
‑tu
cky
Inve
ntor
y of
M
indf
ulne
ss S
kills
Bioi
nfor
mat
ic in
dica
‑tio
ns o
f inc
reas
ed
expr
essi
on o
f pr
o‑in
flam
mat
ory
gene
s lik
e N
F‑kB
tr
ansc
riptio
n fa
ctor
, m
onoc
yte‑
med
iate
d ge
ne e
xpre
ssio
n (w
hile
con
trol
ling
for
sex,
age
, eth
nici
ty,
and
BMI)
Diff
eren
t whi
te b
lood
ce
ll su
btyp
es o
f ge
ne e
xpre
ssio
n ch
ange
s de
term
ined
us
ing
tran
scrip
t or
igin
ana
lysi
sC
‑rea
ctiv
e pr
otei
n an
d in
terle
ukin
‑6 le
vels
m
easu
red
in E
DTA
sa
mpl
es b
y hi
gh
sens
itivi
ty E
LISA
Effec
ts o
f MSB
R on
se
lf‑re
port
ed s
leep
qu
ality
and
exe
rcis
e
‑Sle
ep q
ualit
y m
eas‑
ured
usi
ng P
itts‑
burg
h Sl
eep
Qua
lity
Inde
x m
easu
re‑S
elf‑r
epor
ted
exer
cise
Posi
tive:
MBS
R in
terv
entio
n gr
oup
show
case
a
sign
ifica
nt d
ecre
ase
in lo
nelin
ess
post
‑inte
rven
tion,
co
mpa
red
to a
sm
all d
ecre
ase
in
the
wai
t‑lis
t con
trol
gr
oup.
Sim
ilarly
, aft
er
cont
rolli
ng fo
r bas
e‑lin
e lo
nelin
ess,
MBS
R in
terv
entio
n gr
oup
had
sign
ifica
ntly
lo
wer
lone
lines
s sc
ores
pos
t‑in
terv
en‑
tion
than
con
trol
MBS
R in
terv
entio
n gr
oup
also
had
si
gnifi
cant
redu
c‑tio
ns in
act
ivity
of
NF‑
κB ta
rget
gen
es
post
‑inte
rven
tion
com
pare
d to
con
trol
gr
oup
No
sign
ifica
nt e
ffect
of
inte
rven
tion
on s
leep
qu
ality
was
obs
erve
d
Stud
y D
esig
n: W
ait
list c
ontr
ol g
roup
in
stea
d of
an
activ
e co
mpa
rato
r arm
Inte
rven
tion
Des
ign:
M
indf
ulne
ss m
edita
‑tio
n w
as ta
ught
in
grou
ps in
stea
d of
in
divi
dual
ly. T
each
ing
it in
divi
dual
ly m
ay
have
sho
wn
an
incr
ease
d eff
ect
The
stud
y pr
ovid
es e
vi‑
denc
e th
at a
n 8‑
wee
k M
BSR
inte
rven
tion
redu
ces
perc
eptio
ns
of lo
nelin
ess
in o
lder
ad
ults
. Evi
denc
e al
so s
uppo
rts
that
lo
nelin
ess
is a
ssoc
i‑at
ed w
ith in
crea
sed
activ
ity o
f NF‑
κB
targ
et g
enes
and
that
M
BSR
can
sign
ifica
ntly
do
wnr
egul
ate
this
ge
ne e
xpre
ssio
n in
pa
ralle
l to
lone
lines
s re
duct
ion
Page 25 of 30Saini et al. BMC Psychol (2021) 9:88
Tabl
e 3
(con
tinue
d)
Aut
hor a
nd y
ear
Prim
ary
Out
com
esH
ow P
rim
ary
Out
com
es W
ere
Mea
sure
d
Seco
ndar
y O
utco
mes
How
Sec
onda
ry
Out
com
es W
ere
Mea
sure
d
Mai
n Fi
ndin
gsCh
alle
nges
En
coun
tere
dCo
nclu
sion
Jaza
ieri
et a
l. 20
12 [3
3]M
any
fact
ors
(i.e.
cl
inic
al s
ympt
oms
and
subj
ectiv
e w
ell‑
bein
g) m
easu
red
such
as
soci
al in
ter‑
actio
ns, l
onel
ines
s, de
pres
sive
sym
p‑to
ms,
soci
al a
nxie
ty,
psyc
holo
gica
l str
ess,
self‑
este
em, l
ife
satis
fact
ion,
sel
f‑co
mpa
ssio
n
Lieb
owitz
Soc
ial A
nxi‑
ety
Scal
e‑Se
lf‑Re
port
Soci
al In
tera
ctio
n A
nxi‑
ety
Scal
e St
raig
htfo
r‑w
ard
Scal
eBe
ck D
epre
ssio
n In
vent
ory‑
IIPS
S‑4
Rose
nber
g Se
lf‑Es
teem
Sc
ale
SWLS
SCS,
UC
LA‑8
Lon
eli‑
ness
Sca
le
Not
ava
ilabl
eN
ot a
pplic
able
Posi
tive:
Both
MBS
R an
d ae
robi
c ex
erci
se (A
E) w
ere
linke
d to
a re
duct
ion
in s
ocia
l anx
iety
and
de
pres
sion
, as
wel
l as
an
incr
ease
in s
ub‑
ject
ive
wel
l‑bei
ng.
Ove
rall,
no
sig‑
nific
ant d
iffer
ence
s in
th
ese
mea
sure
s w
ere
seen
bet
wee
n M
BSR
and
AE
Part
icip
ants
in b
oth
the
rand
omiz
ed
cont
rolle
d tr
ial a
nd
the
untr
eate
d so
cial
an
xiet
y di
sord
er
(SA
D) g
roup
sho
wed
im
prov
emen
ts in
th
eir m
easu
res
of
clin
ical
sym
ptom
s an
d w
ell‑b
eing
Stud
y D
esig
n: T
he
resp
ectiv
e gr
oup
expe
rienc
es a
nd
time
enta
iled
in e
ach
inte
ract
ion
may
be
the
caus
e fo
r the
ap
pare
nt d
iffer
ence
s be
twee
n th
e in
ter‑
vent
ion
grou
psSa
mpl
ing:
Stu
dy
requ
ired
part
icip
ants
to
vol
unta
rily
cont
act
rese
arch
ers
to
part
ake
in th
e st
udy,
w
hich
may
hav
e re
sulte
d in
a s
tudy
po
pula
tion
with
less
se
vere
soc
ial a
nxie
ty
Non
‑tra
ditio
nal i
nter
‑ve
ntio
ns s
uch
as M
BSR
and
AE
prod
uce
mod
‑es
t clin
ical
ly s
igni
fican
t ch
ange
s in
soc
ial
anxi
ety,
dep
ress
ion,
an
d su
bjec
tive
wel
l‑be
ing
for p
atie
nts
with
SA
D. H
owev
er, t
hese
ch
ange
s w
ere
not a
t th
e sa
me
leve
l as
wha
t ha
s be
en fo
und
in
prev
ious
stu
dies
with
tr
aditi
onal
trea
tmen
ts
AE a
erob
ic e
xerc
ise,
BAS
Bod
y A
ppre
ciat
ion
Scal
e, B
EM b
rain
edu
catio
n-ba
sed
med
itatio
n, B
MI b
ody
mas
s in
dex,
CBC
T co
gniti
vely
bas
ed c
ompa
ssio
n tr
aini
ng, D
ASS
Dep
ress
ion
Anx
iety
Str
ess
Scal
es, F
CRI F
ear o
f Can
cer
Recu
rren
ce In
vent
ory,
HIV
hum
an im
mun
odefi
cien
cy v
irus,
LDL
low
-den
sity
lipo
prot
ein,
MBC
T m
indf
ulne
ss-b
ased
cog
nitiv
e th
erap
y, M
BSR
min
dful
ness
-bas
ed s
tres
s re
duct
ion
trai
ning
, MSC
min
dful
sel
f-co
mpa
ssio
n, N
F nu
clea
r fac
tor,
PBM
C pe
riphe
ral b
lood
mon
onuc
lear
cel
l, PS
S-4
4-ite
m P
erce
ived
Str
ess
Scal
e, R
NA
ribon
ucle
ic a
cid,
R-U
CLA
Revi
sed
UCL
A, S
AD s
ocia
l anx
iety
dis
orde
r; SC
S Se
lf-Co
mpa
ssio
n Sc
ale,
SF-
1212
-Item
Sho
rt F
orm
H
ealth
Sur
vey,
SH
E st
ress
and
hea
lth e
duca
tion,
SW
LS S
atis
fact
ion
with
Life
Sca
le, T
CC T
ai C
hi C
hih
Page 26 of 30Saini et al. BMC Psychol (2021) 9:88
the degree of loneliness: UCLA Loneliness Scale, with variations of the scale used within the studies (n = 8); 6-item de Jong Gierveld Loneliness Scale (DJGLS-6) (n = 1); baseline and post-treatment surveys to measure impacts of intervention (n = 1); and self-reported ques-tionnaire (n = 1).
In the 2 remaining (15%) studies, one measured social closeness in lonely individuals, rather than directly evalu-ating loneliness [28]. The other study attempted to iden-tify the relationship between NF-κB levels and loneliness [32]. These two studies studied loneliness indirectly, thus the direct effect on loneliness was unclear. Overall, these two studies also reported positive findings, with social
closeness showing significant improvements, as meas-ured with the inclusion of “other” in a self-scale [28], and the Tai Chi intervention group experiencing a significant decrease in levels of psychological stress, while NF-κB remained unchanged post-intervention using blood sam-ples to measure the NF-κB levels [32].
Relatively small randomized control trials conducted over the last decadeEight of the 13 (61%) eligible studies were RCTs, 2 out of 13 (15%) were feasibility studies with an RCT design, 1 out of 13 (8%) was a feasibility and acceptability study, 1 out of 13 (8%) was a pilot study looking at feasibility, and
Table 4 Demographic characteristics of eligible studies
Author and year Age Ethnicity Socioeconomic status Education
Brooker et al. 2020 [22] 38–85 Australian country of birth (n = 23)
Other (n = 4)
N/A Primary (n = 1)Trade/vocational (n = 7)Undergraduate tertiary (n = 6)Postgraduate tertiary (n = 9)
Rodriguez‑Romero et al. 2020 [23]
> = 65 years Hispanic/Spanish Income€ < 750/month (n = 1)€750–1000/month (n = 22)€1000–1500/month (n = 32)
Primary (n = 48)Secondary (n = 6)University (n = 1)
Lee et al. 2019 [24] 57–87 years East Asian (Korean) N/A N/A
Lindsay et al. 2019 [25] 18–70 years Hispanic or Latino (n = 7)Not Hispanic or Latino
(n = 146)
N/A GED (n = 3)High School diploma (n = 20)Technical training (n = 1)Some college (n = 41)Associate degree (n = 10)Bachelor’s degree (n = 48)Master’s degree (n = 26)MD, PhD, JD, PharmD (n = 4)
Pandya 2019 [26] 62–68 South Asian Middle class (n = 147)Upper class (n = 42)
College degree (n = 77)Higher qualifications (n = 112)
Mascaro et al. 2018 [27] 22–30 years N/A N/A Second year medical school
Kok et al. 2017 [28] Adults (mean age 41.15) German—no other informa‑tion provided
N/A N/A
Tkatch et al. 2017 [29] Adults N/A N/A N/A
Dodds et al. 2015 [30] > = 18 years White (n = 11)Not White (n = 1)
< $25,000 (n = 0)$25,000‑$49,999 (n = 3)$50,000‑$99,999 (n = 6) > $100,000 (n = 3)
High school diploma or less (n = 0)
Any college (n = 6)Any graduate school (n = 6)
Samhkaniyan et al. 2015 [31] 20–45 years Iranian (Persian) N/A Minimum pre‑high school diploma
Black et al. 2014 [32] 67.1 ± 7.2 Caucasian (65%) Mean 13.8 ± 4.0 Mean 16.9 years of educa‑tion ± 2.9
Creswell et al. 2012 [9] 55–85 Caucasian (n = 13)African American (n = 2)Asian American (n = 2)Latino(a) (n = 3)Native American (n = 0)Other (n = 0)
N/A High school diploma (n = 0)Some college (n = 6)College degree (n = 3)Graduate work (n = 11)
Jazaieri et al. 2012 [33] Adults (mean 32.87 ± 8.83) Caucasian (n = 13)Asian (n = 14)Hispanic (n = 3)Multiracial (n = 1)
N/A Mean 16.40 ± 2.00 years of education
Page 27 of 30Saini et al. BMC Psychol (2021) 9:88
1 out of 13 (8%) was a quasi-experimental study. All of the studies were also published between 2012 and 2020. Of the studies with an RCT design, all contained small sample sizes, ranging from 22 to 323 participants, with the definition of small sample size depending upon the individual objectives of each study [34]. Small sample sizes are a limitation, considering that in order to limit biases in the intervention groups, the sample size must be large enough to provide statistical power to detect a clinically meaningful treatment effect [35]. Two out of 8 of the RCT studies (25%) mentioned explicitly that due to their small sample sizes, future replications of the stud-ies with larger sample sizes would be warranted [24, 32]. Three out of 8 (37.5%) of the RCT studies made no men-tion of a small sample size limitation, even though their sample sizes were 153, 323, and 48 participants respec-tively [25, 26, 33]. Considering that these three studies created comparisons between two or more groups of subjects, larger studies are needed in order to distinguish between a real effect and random variation [34]. Kok et al. also did not make any mention of having a small sample size (n = 242, after exclusions), however, this may be due to the fact that this trial was embedded within the context of a larger study regarding mental training for healthy adults [28].
Psychosocial factors and ageForty-six percent (6 out of 13) of the studies were con-ducted in populations aged 55 and older [9, 23, 24, 26, 29, 32]. As was noted in many of these studies, loneliness and social isolation are more prevalent in elderly populations, which can lead to numerous negative health outcomes [36]. Rodriguez-Romero et al. stated that loneliness can lead to physical, psychological, and social consequences on health within elderly people, a greater risk for cardio-vascular disease, depressive symptoms, and a worsened quality of life [23]. Pandya et al. focused on discussing the mental health implications that loneliness has on older adults, stating that the transitional life events this demographic faces (i.e. retirement and bereavement) can trigger loneliness [26]. Black et al. and Creswell et al. similarly outlined that older aged people facing loneli-ness are at a greater disposition of all-cause mortality and morbidity [32] and have an increased expression of inflammatory genes, which leads to an increased risk of negative health outcomes [9]. Of the six studies focused on older demographics, 33% (2 out of 6) did not provide age-specific information regarding the negative effects of loneliness [24, 29]. The negative outcomes seen in the older demographic is due to the fact that older people are likely to live alone and tend to be less socially engaged as a result, leading to what is referred to as a loneliness epi-demic [37]. Rodriguez et al. also emphasized that those
aged over 64 years are more likely to face loneliness if they live alone [23]. Two other studies (33%) collected demographic data on study participants who lived alone [26, 29]. Five out of 6 (83%) of these studies found an improvement in loneliness levels through the use of med-itation; the remaining study explored the effects of Tai Chi and meditation on NF-κB signalling in lonely older adults, rather than on loneliness directly [32].
Demographic informationFifteen percent (2 out of 13) of the studies did not pro-vide information regarding the ethnicities of the included participants. The articles that included this information provided a range of ethnic participants, with one study including all South Asian participants [26] and another including all Hispanic/Spanish individuals [23]. Since the studies included collectively comprised of participants from different regions around the world, studies included domestic participants that reflected the make-up of their countries. However, of these participants, it is unknown how many of them were immigrants and how many are native to their countries. Those that experience migra-tion often have feelings of loneliness, which would have been a factor of importance to explore [38].
Nine out of 13 (69%) of the articles did not provide soci-oeconomic information indicating the income and class levels of participants, and 3 out of 13 (23%) provided no indication of the education levels of participants. With respect to socioeconomic status, the studies that provided this information did have a range of participants from vari-ous classes, though there was an evident lack of lower-class individuals. Only one study had a single participant who earned less than €750 a month [23], while no other study provided any evidence of including participants that fell into the lower-socioeconomic class category. Given that current research evidence indicates that loneliness is associated with health-risk behaviours in deprived neighbourhoods, thereby indicating associations to socioeconomic statuses, the inclu-sion of participants from these areas would have provided further insight into the effects of meditation for these indi-viduals [39]. This can similarly be said about the education component since one’s socioeconomic status can directly correlate to their education level [40]. Most of the stud-ies included participants with some sort of schooling, usu-ally having a minimum of a GED or high school diploma. Only 3 of the 10 studies that provided education informa-tion included participants without this qualification, with 2 of the studies including participants with only a primary school education [22, 23] and 1 study having a minimum of a pre-high school degree requirement [31]. Overall, within the included studies there was a lack of reporting account-ing for the diversity (or lack thereof) comprising the demo-graphic characteristics of included participants.
Page 28 of 30Saini et al. BMC Psychol (2021) 9:88
DiscussionThe purpose of the present scoping review was to identify the quantity and type of studies investigating the effects of meditation on loneliness. The available quantity of eligible studies on this topic was relatively small, however, of the 13 eligible studies identified, all reported positive findings. This warrants further research to more comprehensively explore and evaluate the benefits of meditation for those facing loneliness. To our knowledge, this is the first systematically-searched review to report on this topic; our find-ings, therefore, provide both healthcare providers and researchers with a greater awareness of the quantity and type of research studies that have been conducted at the intersection of meditation and loneliness.
Loneliness and its effect on meditation is a topic of growing concern; not only has this topic gained more traction due to the growing demographic of aging popu-lations experiencing loneliness, but there is also a pub-lic concern about how this demographic will burden the healthcare system and affect public finances [37]. Since loneliness leads to negative health outcomes and is dis-proportionately seen in the elderly, a focus on how medi-tation can alleviate loneliness can further reduce the burden on healthcare systems by having these individu-als lead more healthy aging lives [36]. With mediation working to alleviate feelings of loneliness, this can result in various positive health outcomes, such as a lower risk for physiological dysregulation and inflammation [18]. Inflammation, specifically, can lead to the development of various diseases that can cause late-life morbidity and mortality, therefore, lowering one’s risk of inflammation through the alleviation of loneliness can have significant benefits for one’s foreseeable future [9].
It is worth noting that even in many of the ineligible full texts that we had read (but ultimately excluded from this review), social closeness and social isolation were also key focus areas, rather than loneliness, in relation to meditation. Social isolation and loneliness are terms that are often used interchangeably within the litera-ture; we argue that these terms are different, however, as individuals experiencing loneliness may or may not be be socially isolated, and socially isolated people are not always experiencing loneliness [41]. Loneliness is based on how a person feels about their social situation, whereas social isolation is a state regarding one’s social situation (i.e. lack of proximity to others). Loneliness also exists in relation to the perceived lack of connectedness felt from interpersonal relationships, which is why social closeness is often a measure of loneliness [41]. Similar to social isolation, social closeness is a state of being around others, though this does not necessarily mean one does or does not feel lonely. The development of a universally
agreed-upon definition of loneliness is also warranted to better standardize research aiming to evaluate the value of therapies in alleviating this condition. With this in mind, we have identified a number of warranted direc-tions for future research which could build on the pre-sent review’s findings.
Areas identified for future researchRelatively small sample sizes were reported across all 13 eligible studies. In line with future directions proposed in some of these eligible studies, a need exists to con-duct larger scale research studies to better understand the impacts of meditation on loneliness. Goyal et al. [42] conducted a systematic review and found that medita-tion programs were useful in reducing psychological stress and showed small improvements for conditions such as anxiety, depression, and pain. However, similar to our scoping review, all of their included studies had small sample sizes ranging from 15 to 201 patients, which supports this identified need for studies including larger sample sizes. Additionally, across all eligible articles, there was no consistent or unified method for measur-ing participants’ degree of loneliness nor its alleviation; instead, we found 4 methods of measurement across the 13 studies. Eight of the 13 articles (61%) utilized the UCLA Loneliness Scale, while other studies used the DJGLS-6 (n = 1) or their own variation of measure-ment (i.e. baseline and post-treatment surveys, and self-reported questionnaires) (n = 2). Hughes et al. [43] have described the Revised UCLA Loneliness Scale as a long, complex self-administered scale with 20 items and four response categories each. The participant’s responses are summed up, and a higher score indicates greater loneli-ness, making the scale less suitable for telephone surveys in large-scale studies [43]. While this scale is considered to be the most psychometrically sound and most fre-quently used measure for loneliness, it has been criticized for only measuring the social dimension of loneliness, as opposed to the emotional dimension [44]. In contrast, the Three-Item Loneliness Scale gauges general feelings of loneliness well and can be used across two interview modalities (in-person self-administered and telephone), with the possibility existing for this scale to be embedded within the Revised-UCLA (R-UCLA) itself [43]. In com-parison to these methods of measurement, the DJGLS-6 was developed more recently in 2006, taking into account both emotional and social dimensions, but has been less well-evaluated than the R-UCLA [44]. There also appears to be a need to conduct further research that utilizes recently created modes of measurement, such as the DJGLS-6, in order to better evaluate its overall use, reli-ability, and validity [44]. This could serve to inform the creation of a widely accepted measurement of loneliness
Page 29 of 30Saini et al. BMC Psychol (2021) 9:88
that assesses both emotional and social dimensions, which could be used across various interview modalities. Greater knowledge of the specific and targeted benefits (and risks and side effects) of meditation in the context of alleviating loneliness can better assist clinicians in facili-tating shared decision making with their patients regard-ing these interventions [42].
It is also worth noting that the majority of included studies either did not collect or report on the socio-economic status of their participants (69%). Those that did report it, generally had a lack of study participants identifying as belonging to a lower-socioeconomic class and/or without a high school education, therefore, it is unclear whether findings are applicable to these popula-tions. Thus, a need exists for future studies in this area to include participants from diverse backgrounds in order to account for populations which have been understud-ied, as such individuals may suffer disproportionately from loneliness.
Strengths and limitationsNotable strengths of this study included the use of a com-prehensive systematic search strategy to identify eligible articles. Interpretation of these findings was strength-ened by the fact that three authors (GKS, SBH, and ZT) independently screen, data extract, and summarize find-ings, with assistance from the supervising author (JYN). Limitations include the fact that this scoping review did not include non-English language articles, therefore, studies emerging from non-English speaking countries may not have been captured.
ConclusionsThe present scoping review involved a systematic search of the literature to identify the quantity and type of stud-ies investigating the effects of meditation on loneliness. From 13 eligible articles, we identified three major them-esincluding: 1) positive results across all studies, 2) rela-tively small randomized control trials conducted over the last decade, and 3) lack of diverse demographic informa-tion. While a small number of studies exist at this inter-section, given that all included studies reported positive findings, the effects of meditation in alleviating loneli-ness are promising. Based on our findings, future studies should consider the use of newer modes of measurement for loneliness, such as the DJGLS-6 and continue to eval-uate the utility of meditation in alleviating loneliness; this is especially warranted as the COVID-19 pandemic pro-gresses. Future research should also involve larger sample sizes with a range of participants from various back-grounds and be directed at improving our understanding of how meditation serves to alleviate loneliness.
AbbreviationsDJGLS‑6: 6‑Item de Jong Gierveld Loneliness Scale; NF: Nuclear factor; RCT : Randomized control trial; R‑UCLA: Revised UCLA.
AcknowledgementsJYN received a Research Scholarship and an Entrance Scholarship from the Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences at McMaster University.
Authors’ contributionsGKS: collected and analysed data, drafted and critically revised the manuscript, and gave final approval of the version to be published. SBH: collected and analysed data, critically revised the manuscript, and gave final approval of the version to be published. ZT: collected and analysed data, critically revised the manuscript, and gave final approval of the version to be published. JYN: designed and conceptualized the study, collected and analysed data, critically revised the manuscript, and gave final approval of the version to be published. All authors have read and approved the manuscript.
FundingThis study was unfunded.
Availability of data and materialsThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participateThis study involved a scoping review of peer‑reviewed literature only; it did not require ethics approval or consent to participate.
Consent for publicationNot applicable.
Competing interestsThe authors declare that they have no competing interests.
Received: 19 October 2020 Accepted: 10 May 2021
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