How Effective Is Mindfulness-Based Stress Reduction (MBSR)?

Stress is the body's natural reaction to dangerous situations or environments. As a natural response in the body, stress can be positive. However, when it is persistent or severe, it may lead to adverse symptoms in the body and mind. When stress starts to impact one's life, therapeutic programs like mindfulness-based stress reduction (MBSR) may be valuable. The MBSR program has gained widespread recognition and teaches individuals how to cope with stress healthily. 

However, some people may wonder whether MBSR is effective. To understand the effectiveness of this modality, it can be essential to look at the adverse effects of stress, the principles of mindfulness behind the MBSR, and the techniques the program uses, as well as several studies that have investigated MBSR for multiple mental health challenges. 

What is stress?

Stress is your body's natural physical and emotional reaction to changes in your environment, which can cause you to feel threatened. Those changes, called stressors, can be once-in-a-while significant events, such as attending a job interview. They may also be regular everyday events, such as responsibilities at work.

Stress causes a region at the base of your brain, known as the hypothalamus, to incite a series of nerve and hormonal signals in your body. As part of this chain reaction, your adrenal glands, which sit on top of each of your kidneys, send out a rush of hormones, including cortisol and adrenaline. Adrenaline, known as the fight-or-flight hormone, gives you a rush of energy by increasing your heart rate and blood pressure, sending more oxygen-rich blood to your brain and muscles in preparation for your response.

Cortisol, the body's primary stress hormone, boosts the amount of glucose (sugar) in your blood while helping your brain to use the glucose more efficiently. It also increases the metabolism of other nutrients to help with energy production and tissue repair. Other functions of cortisol during the stress response include locking down or slowing some functions that are not deemed necessary in the situation. Those include your growth functions and your reproductive, digestive, and immune systems.

In an average situation, these bodily functions return to baseline, fading your stress once the threat has passed. If the stress response does not subside, it may be due to repeated stressors or severe stress. In those cases, you remain in your heightened ready-to-respond state for a prolonged period, experiencing what is known as chronic stress, in which all body processes continue to occur, leaving your body vulnerable to challenges. 

Potential physical impacts of stress

As stress response hormones continue to be produced, several symptoms related to your chronic or prolonged stress may affect the systems in your body and your emotional state. These adverse effects, such as headaches, backaches, and sleep disturbance, may be readily noticeable. Others may not be so obvious and include the following. 

Type II diabetes 

Your body uses insulin, secreted by your pancreas, to metabolize blood sugar. Stress hormones play a role in insulin resistance. Along with higher blood sugar levels brought on by chronic stress, these hormones may lead to type II diabetes in the long term. 

A suppressed immune system

By suppressing your immune system, stress leaves you vulnerable to infections like the flu or common cold. Coupled with your increased susceptibility to infections is the body's slower ability to heal itself. With chronic stress, you may get sick quickly and stay sick longer.

Irritable bowel syndrome and stomach ulcers

The hormones produced by your thyroid glands play a role in metabolism. Chronic stress affects your thyroid glands and their hormone production, which can lead to irritable bowel syndrome (IBS). This condition often manifests as constipation but can also affect some people through diarrhea or alternations between the two. 

Acne and hair loss 

Stress causes a spike in the amount of androgen (a sex hormone) in your system. This spike leads to an increased risk of hair loss and acne breakouts. When coupled with your lowered immune system response, it can cause you to develop rashes on other areas of your skin apart from your face.

Changes in brain structure 

Stress hormones have been shown to cause long-term changes in your brain structure and how it functions. Prolonged heightened cortisol levels are thought to lead to brain damage, where the hippocampus (a section of your brain responsible for memory and emotions) begins to shrink. This shrinkage can lead to memory loss and a host of emotional disorders.

Anxiety, irritability, and depression 

Along with memory loss, the effects of stress on your brain can directly lead to increased anxiety, irritability, and depression. These effects can also occur indirectly as a reaction to the negative symptoms you are feeling due to stress and potentially a sense of helplessness.

Sexual dysfunction 

Besides negatively affecting your sexuality, chronic stress may lead to low sperm production and erectile dysfunction in men. It also leaves them with an increased risk of developing infections of the prostate and testes. Those with gynecological reproductive systems experiencing chronic stress may experience heavier, irregular, and more painful periods. Alternatively, if they are going through menopause, their physical symptoms may be intensified.

Mindfulness and the MBSR program

Below are some facts about mindfulness and the MBSR therapy program's development. 

Who was the founder of MBSR? 

Jon Kabat-Zinn earned his Ph.D. in molecular biology in 1971 at MIT, where he was exposed to the Buddhist concept of mindfulness. Under the guidance of a Buddhist monk and a Zen master, he studied mindfulness and other Buddhist practices. By 1979, he adapted what he had learned into a structured eight-week program called Mindfulness-Based Stress Reduction. That same year (1979), Kabat-Zinn established the Stress Reduction Clinic at the University of Massachusetts Medical School, where he was, and still is, a professor.

Mindfulness in Buddhism

Mindfulness (awareness) is one of the essential principles of Buddhism. It is rooted in Vedic tradition and is one of the steps to enlightenment in this religion. Buddhism teaches mindfulness as a way of living in the present moment so that the individual can cultivate self-knowledge and wisdom. While the teachings of Buddhism have influenced mindfulness-based stress reduction techniques, the MBSR program is not religious, and mindfulness can be practiced secularly. 

Mindfulness in modern psychology

In modern psychology, mindfulness is a way of handling one's emotions without avoiding—nor overindulgence in—your emotions. It is a way to develop behavioral recognition, awareness of self, and metacognition (awareness of your awareness). Mindfulness is sometimes viewed in three interrelated ways.

Firstly, it is a predisposition or a trait in some individuals who seem naturally more mindful than others. Secondly, mindfulness is a learned state of awareness where you are taught how to focus on the present moment. Thirdly, it is the practice of mindful meditation that takes you into the state of mindfulness.

Mindfulness in medical settings

Throughout history, medicine in several cultures has treated the mind and body as two interconnected and interdependent halves of a whole—the person. Western medicine veered away from this concept in the 1600s and has only recently returned to embracing the holistic nature of wellness.

Mindfulness, as it is now widely used in medicine, grew out of Jon Kabat-Zinn's MBSR program, which he initially developed to provide pain relief to the chronically ill. Many hospitals and health centers worldwide teach mindfulness as a coping strategy to patients experiencing chronic pain, anxiety, and depression, among other conditions. Mindfulness-based stress reduction, as a therapy in inpatient and outpatient care, has been shown to provide comparable relief to some painkillers. 

How does MBSR work?

The MBSR is offered in a group, face-to-face setting, but participants still receive one-on-one attention from instructors with some aspects of the course tailored to individual needs. The group setting is encouraged for the support participants can give and receive, which may ensure successful completion. However, the group setting is not required, as there are online options for those who cannot attend in-person classes. In these cases, group interaction may be encouraged through forum posts. There are also intensive programs that cover the MBSR in five full days and are often attended as residential courses. However, these are also not mandatory. 

Throughout the course, participants are exposed to the foundations and theory of mindfulness. They also learn about stress as a physical and psychological process, how it affects the mind and body, and how to temper their reaction to it. While MBSR falls within the realm of what is commonly described as complementary and alternative medicine (CAM), it is not meant to replace formal medical or psychological care by your healthcare provider. The course focuses on the following elements. 

Body scanning 

Participants are taught to pay conscious attention to each part of the body. It is often done lying down, with the focus beginning at the toes moving up to the head. It can, however, be accomplished in any position and from head to toe instead.

Mindful eating 

Mindful eating involves learning to focus on what and why you eat by becoming aware of whether your mind, heart, or body is "hungry." Participants are also taught to become more aware of their hunger and when hunger is satisfied. This technique may help reduce binge eating and reliance on comfort food.

Mindful breathing 

Mindful breathing is a technique that aids concentration as you focus on each inhaled and exhaled breath. It develops your alertness and awareness while helping you control anxiety and restlessness.

Gentle stretches and mindful hatha yoga 

Hatha yoga is a gentle and slow form of yoga poses and breathing exercises done relaxedly. It may be a positive style for beginners, as it allows them to get into poses easier and hold them longer.

Sitting meditation 

Sitting meditation is taught to enhance concentration and focus on the body. It helps participants apply mindfulness techniques in their everyday lives.

Walking meditation 

In walking meditation, participants learn to focus on the world around them as they also pay close attention to their breathing and movement. It can be applied as you go about your daily routine.

Interpersonal mindfulness 

The interpersonal mindfulness section involves learning to interact with others compassionately, making it easier to handle differing points of view. It teaches awareness of how you are affected by the actions of others and how your actions affect them as well.

What has research into the use of MBSR discovered?

The use of the MBSR as a complementary treatment has been studied extensively since its inception. Many of these studies have found positive results that speak to the program's effectiveness, including the following. 

MBSR and chronic illnesses

In 2011, the North American Journal of Medical Sciences published a study into the use of MBSR for chronic illnesses such as depression, chronic pain, hypertension, and skin and immune disorders. The study was a meta-analysis and looked at the results of 18 previous studies. The researchers concluded that "MBSR improves the condition of patients experiencing chronic illnesses and helps them cope with a wide variety of clinical problems."

MBSR and low back pain 

The National Institutes of Health (NIH) highlights research conducted into the use of MBSR, cognitive-behavioral therapy (CBT), and conventional approaches to treating clients ranging from 20 to 70 years old experiencing low back pain. Researchers found that the MBSR and CBT groups showed marked improvement six months and one year after the initial study.

The lead researcher, Dr. Daniel Cherkin, noted, "The research suggests that training the brain to respond differently to pain signals may be more effective—and last longer—than traditional physical therapy and medication." The NIH also points to another study that found MBSR more cost-effective than conventional treatment alone.

MBSR and breast cancer 

Mindfulness-based cognitive therapy (MBCT) is an offshoot of MBSR intended to specifically help individuals with recurrent depression. One study took the form of an analysis of cases in which MBSR and MBCT were used among various patients with breast cancer to see how their "health-related quality of life and psychological health" were impacted by the programs as compared with conventional care. The researchers concluded that there was some evidence of MBCT's effectiveness in improving psychological health in breast cancer patients.

MBSR and insomnia 

In a study of 54 individuals with chronic insomnia, researchers found marked and sustained improvements for those who participated in either the MBSR program or a mindfulness-based therapy for insomnia (MBTI) developed from the MBSR. The results were compared to the use of self-monitoring with sleep diaries. The most significant improvements were shown in the specially tailored MBTI.

MBSR and ulcerative colitis 

Stress is known to cause flare-ups in ulcerative colitis (incurable chronic inflammatory bowel disease). A study focused on using MBSR to manage and reduce stress in patients with ulcerative colitis found that they experienced reduced perceived stress and enjoyed a greater quality of life after exposure to the MBSR.

MBSR and social anxiety disorder 

A minor study used functional magnetic resonance imaging (fMRI) to measure brain activity in individuals experiencing social anxiety disorder before and after exposure to MBSR. The researchers reported positive results from the post-MBSR scans and "improvement in anxiety and depression symptoms and self-esteem" among the participants.

MBSR and multiple sclerosis 

One 2014 study comprised 40 women aged 20 to 50, all diagnosed with multiple sclerosis. Researchers split the group in two, with one group receiving MBSR training and the other receiving standard treatment. Anxiety, depression, and stress levels showed significant reduction among the group exposed to MBSR techniques.

How effective is mindfulness-based stress reduction?

Stress can be seen as a double-edged sword. On one hand, it may cause you to develop various physical, mental, and emotional illnesses. On the other hand, many illnesses lead to stress and are exacerbated by it. Finding effective methods of preventing and managing stress in healthy individuals and those with existing medical conditions becomes a priority. Mindfulness-based stress reduction is one such method whose effectiveness has been proven by scientific studies. 

Several government bodies have recognized the effectiveness of this therapeutic modality. Furthermore, The National Institute on Aging lists mindfulness as one of several remedies that have been proven helpful for pain associated with several conditions, as well as for the symptoms of menopause. While MBSR conducted in person is the most common, a study conducted during the COVID-19 pandemic noted the effectiveness of an online MBSR course.

Support options 

It has been decades since Jon Kabat-Zinn, Ph.D. founded the Mindfulness-Based Stress Reduction program. In that time, it has earned a well-deserved reputation as an effective method for reducing the ill effects of stress and for the coping strategies it teaches. If you're interested in learning mindfulness, consider contacting a mindfulness-based therapist online or in your area.

Modalities like mindfulness-based stress reduction and mindfulness-based cognitive therapy can be adapted to be taught through online platforms like BetterHelp. If you face barriers to in-person therapy, online platforms can allow you to connect with a provider from home. Your therapist can send you worksheets, group session recommendations, webinar links, and journaling prompts. In addition, you can send messages to your provider outside of sessions for support. 

One study looked at mindfulness-based cognitive therapy in the treatment of anxiety and depression online. The researchers found that this format of mindfulness therapy can be as effective as in-person options and may be more convenient for some clients.