Mood Disorders Centre, Exeter University, Exeter, UK.
Medical School, Exeter University, Exeter, UK.
Clin Psychol Rev. 2017 Jul;55:74-91. doi: 10.1016/j.cpr.2017.04.008. Epub 2017 Apr 23.
Recently, there has been an increased interest in studying the effects of mindfulness-based interventions for people with psychological and physical problems. However, the mechanisms of action in these interventions that lead to beneficial physical and psychological outcomes have yet to be clearly identified.
The aim of this paper is to review, systematically, the evidence to date on the mechanisms of action in mindfulness interventions in populations with physical and/or psychological conditions.
Searches of seven databases (PsycINFO, Medline (Ovid), Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, AMED, ClinicalTrials.gov) were undertaken in June 2014 and July 2015. We evaluated to what extent the studies we identified met the criteria suggested by Kazdin for establishing mechanisms of action within a psychological treatment (2007, 2009).
We identified four trials examining mechanisms of mindfulness interventions in those with comorbid psychological and physical health problems and 14 in those with psychological conditions. These studies examined a diverse range of potential mechanisms, including mindfulness and rumination. Of these candidate mechanisms, the most consistent finding was that greater self-reported change in mindfulness mediated superior clinical outcomes. However, very few studies fully met the Kazdin criteria for examining treatment mechanisms.
There was evidence that global changes in mindfulness are linked to better outcomes. This evidence pertained more to interventions targeting psychological rather than physical health conditions. While there is promising evidence that MBCT/MBSR intervention effects are mediated by hypothesised mechanisms, there is a lack of methodological rigour in the field of testing mechanisms of action for both MBCT and MBSR, which precludes definitive conclusions.
最近，人们对研究正念干预对心理和生理问题人群的影响产生了浓厚的兴趣。然而，这些干预措施导致有益的生理和心理结果的作用机制尚未明确。
本文旨在系统回顾目前有生理和/或心理状况人群的正念干预作用机制的证据。
我们于 2014 年 6 月和 2015 年 7 月在七个数据库（PsycINFO、Medline（Ovid）、Cochrane 对照试验中心注册库、EMBASE、CINAHL、AMED、ClinicalTrials.gov）中进行了检索。我们评估了我们确定的研究在多大程度上符合 Kazdin（2007、2009）提出的在心理治疗中确定作用机制的标准。
我们确定了四项针对共患心理和生理健康问题人群的正念干预作用机制的研究，以及 14 项针对心理状况人群的研究。这些研究考察了一系列潜在的机制，包括正念和反刍。在这些候选机制中，最一致的发现是，正念的自我报告变化越大，临床结果越好。然而，很少有研究完全符合 Kazdin 检查治疗机制的标准。
有证据表明，整体正念变化与更好的结果相关。这一证据更多地涉及针对心理健康而非身体健康状况的干预措施。虽然有有希望的证据表明 MBCT/MBSR 干预效果是由假设的机制介导的，但在测试 MBCT 和 MBSR 的作用机制方面，该领域缺乏方法学严谨性，因此无法得出明确的结论。
