Nature-based mindfulness programs using virtual reality to reduce pediatric perioperative anxiety: a narrative review.

Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.

Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial.

Background: Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health. Methods: We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital. Data analysis: Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ). Discussion: Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Tri-process model of interpersonal mindfulness: theoretical framework and study protocol.

According to the Center for Disease Control and Prevention, over 14% of the US population practice mindfulness meditation. The effects of mindfulness training on physical and mental health have been consistently documented, but its effects on interpersonal relationships are not yet fully understood or investigated. Interpersonal relationships play a crucial role in the wellbeing of individuals and society, and therefore, warrants further study. The aim of this paper is to present a tri-process theoretical model of interpersonal mindfulness and a study protocol to validate the proposed model. Specifically, according to the proposed model, mindfulness meditation training increases the self-awareness, self-regulation, and prosociality of those receiving the training, which ameliorates the quality of interpersonal interactions and the socioemotional support provided to other individuals. Finally, better socioemotional support increases the support receiver's ability to regulate their emotions. Using a multiphasic longitudinal design involving 640 participants randomized into 480 dyads, the proposed protocol aims to validate the tri-process model and to investigate its mechanisms of actions. The proposed study has important theoretical and social implications and will allow devising new and more effective interpersonal mindfulness programs with applications in multiple fields.

Mindfulness-based programs and school adjustment: A systematic review and meta-analysis.

Mindfulness-based programs (MBPs) are increasingly used in educational institutions to enhance students' mental health and resilience. However, reviews of the literature suggest this use may have outpaced the evidence base and further research is needed to better understand the mechanisms underlying these programs' effectiveness and which outcomes are being affected. The purpose of this meta-analysis was to investigate the strength of MBPs' effects on school adjustment and mindfulness outcomes while also considering the potential influence of study and program characteristics, including the role of comparison groups, students' educational level, the type of program being used, and the facilitator's training and previous mindfulness experience. Following a systematic review of five databases, 46 studies using a randomized controlled design with students from preschool to undergraduate levels were selected. At post-program, the effect of MBPs compared to control groups was (a) small for overall school adjustment outcomes, academic performance, and impulsivity; (b) small to moderate for attention; and (c) moderate for mindfulness. No differences emerged for interpersonal skills, school functioning, or student behaviour. The effects of MBPs on overall school adjustment and mindfulness differed based on students' educational level and the type of program being delivered. Moreover, only MBPs delivered by outside facilitators with previous experience of mindfulness had significant effects on either school adjustment or mindfulness. This meta-analysis provides promising evidence of the effectiveness of MBPs in educational contexts to improve students' school adjustment outcomes beyond typically assessed psychological benefits, even when using randomized controlled designs.

The Effect of Mindfulness-Based Stress Reduction (MBSR) on Emotional Flexibility and Ambivalence Over Emotional Expression in Divorced Women: A Pilot Randomized Controlled Trial.

ABSTRACT: The present study was developed to evaluate the effects of mindfulness-based stress reduction (MBSR) on the level of emotional flexibility and ambivalence related to emotional expression of divorced women. A general community sample of 30 divorced women was recruited and randomly assigned to experimental and control groups. The experimental group received MBSR for 8 weeks, and the control group was placed on a waiting list. The Emotional Flexibility Questionnaire (EFQ) and the Ambivalence Over the Expression of Emotion Questionnaire (AEQ) were administered to both groups before (pre) and after (post) the treatment. Data were analyzed using two-way mixed repeated-measures analyses of variance. The results showed that women in the treatment group had a significant increase in the total score of the EFQ and its components. In addition, the MBSR group had a significant decrease in the total score of the AEQ and its components. MBSR intervention shows potential for use with divorced women to help with emotion regulation and subsequent better adjustment to separation.

Embodied Mindfulness Questionnaire: Scale Development and Validation.

Recently developed mindfulness scales have integrated aspects of the body in measuring mindfulness unlike other established scales. However, these scales focused solely on body awareness and did not embrace all aspects of mindfulness and the body. Specifically, they did not integrate embodiment in mindfulness. The proposed Embodied Mindfulness Questionnaire (EMQ) aims to operationalize the proposed notion of "embodied mindfulness" by grounding it into five dimensions, each representing a set of skills that can be cultivated through training and practice: (a) Detachment from Automatic Thinking, (b) Attention and Awareness of Feelings and Bodily Sensations, (c) Connection with the Body, (d) Awareness of the Mind-Body Connection, and (e) Acceptance of Feelings and Bodily Sensations. The EMQ items were developed through consultations with a panel of eight graduate students and a group of 10 experts in the field. Results from a series of three studies supported the proposed five subscales of EMQ and suggested that these subscales are independent and supported by convergent and discriminant evidence. In addition, results suggested that scores of EMQ subscales are different in terms of sensitivity to mindfulness training or meditation practice and experience. Limitations, as well as theoretical and practical implications of the EMQ subscales, are thoroughly discussed.

Self-compassion, Mindfulness, Stress, and Self-esteem Among Vietnamese University Students: Psychological Well-being and Positive Emotion as Mediators.

Objectives: Theory and prior research suggest that improving self-esteem is a promising way to improve students' academic performance and mental health. This study empirically examines the mediating effect of psychological well-being and positive emotion in the relationships between self-compassion, mindfulness, stress, and self-esteem. Methods: An explanatory sequential mixed-method design was employed. Quantitative data collected through a two-wave survey from 654 Vietnamese students were analyzed to test the hypotheses using SPSS 22.0 and AMOS 24.0. Data from 19 in-depth interviews were used to explain the quantitative findings and explore students' experiences in practicing mindfulness and self-compassion. Results: Findings revealed that psychological well-being and positive emotion fully mediated the relationships between self-compassion, mindfulness, stress, and self-esteem. Conclusions: Results of this study highlight the importance of psychological well-being and positive emotion in the self-compassion, mindfulness, stress, and self-esteem relationship, as well as explain a possible process by which factors help university students achieve and sustain a sense of high self-esteem. Ultimately, this study has identified several potential targets for intervention strategies in mental health, such as mindfulness and self-compassion among university students.

Interpersonal Mindfulness Questionnaire: Scale Development and Validation.

Objectives: Previously developed mindfulness measures focused on its intrapersonal dimensions and did not measure the interpersonal aspects of mindfulness. Furthermore, recently developed interpersonal mindfulness measures were either specific to a certain context (e.g., parenting, conjugal, teaching) or omitted/minimized the role of the body in the interpersonal dynamic. The proposed Interpersonal Mindfulness Questionnaire (IMQ) aims to operationalize the theoretical notion of embodied and embedded mindfulness by grounding it into four dimensions, each representing a set of skills that can be cultivated through training and practice: (1) Detachment from the Mind, (2) Body-Anchored Presence, (3) Attention to and Awareness of the Other Person, and (4) Mindful Responding. Methods: The IMQ subscales were developed through consultations with a panel of eight graduate students and ten experts in the field. Three studies were conducted to evaluate the construct, internal consistency, reliability, convergent validity, and utility of the IMQ. Results: Findings from the three studies supported the proposed four subscales of IMQ and suggested that these four subscales are independent and supported by convergent evidence. In addition, results suggested that IMQ subscales' scores are sensitive to meditation experience and are associated with better intrapersonal and interpersonal outcomes. Conclusions: IMQ subscales are valid and are consistent with the proposed embodied and embedded conception of interpersonal mindfulness. IMQ subscales are associated with intrapersonal mindfulness, but not strongly enough to be conceived as the same phenomenon. Limitations, as well as theoretical and practical implications of IMQ subscales, are thoroughly discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-01855-1.

Resilience and Stress as Mediators in the Relationship of Mindfulness and Happiness.

The aim of the present study was to examine the mediation effects of resilience and stress, two perceived opposite constructs, in the relationship between mindfulness and happiness. Mindful Attention Awareness Scale, Connor-Davidson Resilience Scale, Subjective Happiness Scale, Depression Anxiety Stress Scales short version-21 were administered to 523 undergraduate university students in India. Structural Equation Modeling with bootstrapping was applied to test the mediating effects of resilience and stress. Results showed that resilience and stress partially mediated the mindfulness-happiness relationship. In addition, resilience partially mediated the relationship of mindfulness to stress. Findings suggest that mindfulness may play an influential role in enhancing happiness through the mediating effects of resilience and stress.

Which emotion-regulation strategies explain the relationship between dispositional mindfulness, self-compassion, and eating to cope?

Eating in response or to cope with negative emotions has been shown to be problematic in undergraduate students. Dispositional mindfulness and self-compassion have been associated with less eating in response or to cope with negative emotions; however, specific mechanisms underlying these relationships have never been tested. The aim of the present study is to test whether lower levels of specific difficulties in emotion-regulation (i.e., non-acceptance of emotional responses, difficulties engaging in goal-directed behaviour, impulse control difficulties, lack of emotional awareness, limited access to emotion-regulation strategies, lack of emotional clarity) explain the negative relationship between dispositional mindfulness and self-compassion with eating to cope. Undergraduate students (N = 307) aged 18 to 24 (M = 20.28) completed online self-report measures. Dispositional mindfulness and self-compassion were associated with lower levels of non-acceptance of emotional responses, which in turn was associated with less eating to cope. Dispositional mindfulness and self-compassion were also associated with lower levels of difficulties engaging in goal-directed behaviour; however, difficulties engaging in goal-directed behaviour was unexpectedly associated with less eating to cope. To note, dispositional mindfulness was not associated with eating to cope when holding self-compassion constant. Results suggest that specific difficulties in emotion-regulation may explain the negative relationship between dispositional mindfulness and self-compassion with eating to cope. Findings contribute to theoretical models, and with replication can be used to inform the development of randomized-control trials examining the efficacy of mindfulness and self-compassion-based training for eating to cope in undergraduate students.

Examining the Relationship Between Mindfulness, Self-Compassion, and Emotion Regulation in Self-Injury.

OBJECTIVE: The objective of the current study was to investigate whether mindfulness and self-compassion are negatively associated with engagement in non-suicidal self-injury (NSSI) and whether emotion dysregulation would mediate this relation. METHOD: 343 participants (82.2% female; Mage = 23.98; SD = 7.47) were recruited from university and community settings, and completed online questionnaires. Two groups of participants were created: those with lifetime engagement in NSSI (n = 153) and a comparison group with no prior engagement in NSSI (n = 190). RESULTS: First, two one-way MANOVAs revealed significant mean differences (NSSI/comparison) across the self-compassion dimensions and specific mindfulness facets. Second, logistic regressions revealed that the self-coldness dimension of self-compassion significantly predicted engagement in NSSI, and specific mindfulness facets (nonjudging and acting with awareness) were found to negatively predict NSSI engagement. Lastly, mediation analyses revealed that emotion dysregulation fully mediated the relationships between both mindfulness total and self-coldness, and NSSI group status. CONCLUSION: The present study demonstrates preliminary support for the protective role of key mindfulness facets and potential risk of the self-coldness aspect of self-compassion in NSSI engagement. Implications for potential use of treatment protocols may include teaching key aspects of mindfulness and self-compassion as healthier and kinder alternatives to coping with dysregulated emotions.HighlightsMindfulness and self-compassion significantly differ between NSSI/comparison groupsKey mindfulness facets and self-compassion dimensions negatively predict engagement in NSSIEmotion dysregulation fully mediates self-coldness and mindfulness with NSSI group status.

Mindfulness facets, self-compassion, and drinking to cope: How do associations differ by gender in undergraduates with harmful alcohol consumption?

Objective: Undergraduate students show high rates of harmful alcohol consumption, and coping-motivated use has been consistently shown to be the most problematic. The present study examines associations between mindfulness facets, self-compassion, and coping-motivated use, and how these associations differ by gender. Participants and Methods: Undergraduate students reporting harmful alcohol consumption (N = 146; 55.5% women) completed self-report measures assessing their dispositional mindfulness facets, self-compassion, and drinking motives. Results: Regression analyses revealed that for both genders, mindfulness facets and self-compassion were negatively associated with drinking to cope with depression, but not anxiety. Non-judging was uniquely negatively associated with drinking to cope with depression in women, but in men, non-reactivity was the sole unique association. Conclusions: Future research should investigate whether mindfulness and self-compassion training for undergraduates with harmful alcohol consumption is more effective if they target students who drink to cope with depression and emphasize different skills depending on the student's gender.

Specific emotion-regulation processes explain the relationship between mindfulness and self-compassion with coping-motivated alcohol and marijuana use.

Previous research has established coping-motivated use to be the most problematic form of substance use. While dispositional mindfulness and self-compassion have been associated with lower levels of coping-motivated use in undergraduate students, possible mechanisms underlying these relationships have never been tested. The present two-part study examines whether specific emotion-regulation processes underlie the negative relationship between mindfulness and self-compassion with drinking to cope with depression and anxiety (Study One) and coping-motivated marijuana use (Study Two). The study also tests an alternative model examining whether difficulties in emotion-regulation is associated with lower levels of specific mindfulness skills, and in turn higher levels of coping-motivated use. Undergraduate students completed self-report measures assessing their levels of dispositional mindfulness, self-compassion, difficulties in emotion-regulation, and coping-motivated alcohol and marijuana use. In Study One (N = 187), mediation analyses revealed that mindfulness and self-compassion were associated with higher levels of access to emotion-regulation strategies, which in turn was associated with lower levels of drinking to cope with depression, but not anxiety. In Study Two (N = 170), mediation analyses revealed that mindfulness and self-compassion were associated with higher levels of acceptance of emotional responses, which in turn was associated with lower levels of coping-motivated marijuana use. In the alternative model, the mindfulness skill of acting with awareness partially explained the relationship between difficulties in emotion-regulation and drinking to cope with depression and anxiety, but not coping-motivated marijuana use. Results contribute to theoretical models and implications are discussed.

Evaluating the Use of Mindfulness and Yoga Training on Forensic Inpatients: A Pilot Study.

Forensic inpatients (i. e., individuals found not responsible for a criminal offense on account of mental illness) represent an often marginalized and difficult-to-treat population. This has led to the need for research exploring the effectiveness of novel interventions. A Canadian forensic hospital has developed an 8-weeks mindfulness and yoga training program (MTP). This pilot study examined the potential effects of this program on patients' mindfulness, stress, and use of cognitive and emotion regulation strategies. A sample of 13 forensic inpatients (male = 92%) participating in the MTP program completed self-report measures assessing dispositional mindfulness, perceived stress, and use of cognitive emotion regulation strategies at baseline, post-intervention, and a 3-months follow-up. Repeated measure ANOVAs found a significant increase in the describe facet of mindfulness (p = 0.03) with a large effect size (ηp 2 = 0.26) and a significant decrease in stress (p = 0.003) with a large effect size (ηp 2 = 0.39). Pairwise comparisons revealed medium to large significant changes between baseline and post-intervention for both the describe facet (p = 0.03, Hedge's g = 0.55) and stress (p = 0.003, Hedge's g = 0.70). However, comparisons were insignificant between baseline and follow-up. No significant main effects were found on the use of cognitive emotion regulation strategies. This pilot study offers preliminary support for the use of the MTP as an adjunctive therapy in forensic inpatient treatment. Further investigation is needed into the long-term impacts of this training.

Mindfulness induction and cognition: A systematic review and meta-analysis.

Mindfulness meditation might improve a variety of cognitive processes, but the available evidence remains fragmented. This preregistered meta-analysis (PROSPERO-CRD42018100320) aimed to provide insight into this hypothesis by assessing the effects of brief mindful attention induction on cognition. Articles were retrieved from Pubmed, PsycInfo and Web of Science up until August 1, 2018. A total of 34 studies were included. The outcomes were categorized into four cognitive domains: attentional functioning, memory, executive functioning and higher-order function. A small effect was found across all cognitive domains (Hedges' g = 0.18, 95% IC = 0.07-0.29). Separated analyses for each cognitive domain revealed an effect only in higher-order cognitive functions (k = 10, Hedges' g = 0.35, 95% IC = 0.20-0.50). Results suggest that mindfulness induction improves cognitive performance in tasks involving complex higher-order functions. There was no evidence of publication bias, but studies generally presented many methodological flaws.

Mindfulness-Based Interventions for the Improvement of Well-Being in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: The study aims to meta-analytically review studies about the effects of mindfulness-based interventions (MBIs) on well-being of people with multiple sclerosis (MS). METHODS: Seven electronic databases were searched from June 2018 to September 2018. A systematic review and a meta-analysis were conducted. RESULTS: Twenty-one studies were included in qualitative synthesis, and 10 studies were included in meta-analysis. MBIs are effective with an overall moderate effect size (Hedges' g = 0.70) in improving well-being in people with MS, with lasting effects at the follow-up (g = 0.55). In particular, MBIs demonstrated to highly reduce stress (g = 1.07) and to improve depression and anxiety symptoms with a moderate to large effect at postintervention (g = 0.77 and g = 0.63, respectively). CONCLUSIONS: MBIs represent a valid and effective mind-body intervention to improve the well-being of patients with MS. Further studies should investigate which components of MBIs could be more beneficial for patients with progressive MS. PROSPERO REGISTRATION: CRD42018099704.

Behavioral and Cognitive Impacts of Mindfulness-Based Interventions on Adults with Attention-Deficit Hyperactivity Disorder: A Systematic Review.

Mindfulness-based interventions (MBIs) are becoming increasingly popular as treatments for physical and psychological problems. Recently, several studies have suggested that MBIs may also be effective in reducing symptoms of attention-deficit hyperactivity disorder (ADHD). Most studies have examined the effectiveness in children, but there are now a sufficient number of individual treatment trials to consider a systematic review in adults. Majority of existing systematic reviews and meta-analyses only consider ADHD symptoms as an outcome, and most of them do not fully report potential biases of included studies, thus limiting considerably their conclusions. This is an important facet because some studies could be found ineligible to be included in future analysis due to their low quality. In this systematic review, we followed the PRISMA/PICO criteria and we thoroughly assessed the risks of bias for each of the selected studies according to Cochrane guidelines. We searched the available literature concerning MBIs in adult participants with ADHD using PsycINFO, PubMed, Scopus, and ERIC databases. In total, 13 studies conducted with 753 adults (mean age of 35.1 years) were identified as eligible. Potential moderators such as participants' age, ADHD subtypes, medication status, comorbidity, intervention length, mindfulness techniques, homework amount, and training of therapists were carefully described. Aside from measuring the symptoms of ADHD, outcome measures were categorized into executive/cognitive functioning, emotional disturbances, quality of life, mindfulness, and grade point average at school. According to presented descriptive results, all the studies (100%) showed improvement of ADHD symptoms. In addition, mindfulness meditation training improves some aspects of executive function and emotion dysregulation. Although these are promising findings to support treatment efficacy of MBIs for ADHD, various biases such as absence of randomization and lack of a control group may affect the actual clinical value and implications of the studies. Moreover, the relatively low quality of selection and performance criteria in several studies, as well as relatively high attrition bias across studies, call for caution before considering conducting further analysis.

Mindfulness training for healthcare professionals and trainees: A meta-analysis of randomized controlled trials.

OBJECTIVE: Healthcare professionals (HCPs) experience a wide range of physical and psychological symptoms that can affect quality of patient care. Previous meta-analyses exploring mindfulness-based interventions (MBIs) for HCPs have been limited by their narrow scope regarding intervention type, target population, and/or measures, and reliance on uncontrolled studies; therefore, a more comprehensive and methodologically rigorous examination is warranted. This meta-analysis quantified the effectiveness of MBIs on distress, well-being, physical health, and performance in HCPs and HCPs-in-training. METHOD: RCTs examining the effect of meditation and MBIs on HCPs and HCPs-in-training were identified and reviewed. Two independent reviewers extracted data and assessed risk of bias. RESULTS: Thirty-eight studies were included in the analyses (n = 2505; 75.88% female). Intervention had a significant moderate effect on anxiety (Hedge's g = 0.47), depression (Hedge's g = 0.41), psychological distress (Hedge's g = 0.46), and stress (Hedge's g = 0.52). Small to moderate effects were also found for burnout (Hedge's g = 0.26) and well-being at post-intervention (Hedge's g = 0.32). Effects were not significant for physical health and performance. Larger intervention effects on overall outcomes were found with HCPs (Hedge's g = 0.52), with Mindfulness-based Stress Reduction intervention (Hedge's g = 0.47), and inactive controls (Hedge's g = 0.36). CONCLUSIONS: Results suggest mindfulness-based interventions are effective in reducing distress and improving well-being in HCPs and HCP-ITs. Subgroup analyses suggest the importance of exploring potential participants' needs prior to selecting the type of mindfulness intervention. Future studies should assess changes in mindfulness and include active controls.

Effectiveness of traditional meditation retreats: A systematic review and meta-analysis.

BACKGROUND: An increasing number of studies are investigating traditional meditation retreats. Very little, however, is known about their effectiveness. OBJECTIVE: To evaluate the effectiveness of meditation retreats on improving psychological outcomes in general population. DATA SOURCES: A systematic review of studies published in journals or as dissertations in PSYCINFO, PUBMED, CINAHL or Web of Science from the first available date until October 22, 2016. REVIEW METHODS: A total of 20 papers (21 studies, N=2912) were included. RESULTS: Effect-size estimates of outcomes combined suggested that traditional meditation retreats are moderately effective in pre-post analyses (n=19; Hedge's g=0.45; 95% CI [0.35, 0.54], p<0.00001) and in analyses comparing retreats to controls (n=14; Hedge's g=0.49; 95% CI [0.36, 0.61], p<0.00001). Results were maintained at follow-up. No differences were observed between meditation styles. Results suggested large effects on measures of anxiety, depression and stress, and moderate effects on measures of emotional regulation and quality of life. As to potential mechanisms of actions, results showed large effects on measures of mindfulness and compassion, and moderate effects on measures of acceptance. In addition, changes in mindfulness levels strongly moderated clinical effect sizes. However, heterogeneity was significant among trials, probably due to differences in study designs, types and duration of the retreats and assessed outcomes, limiting therefore the implications of the results. CONCLUSION: Meditation retreats are moderately to largely effective in reducing depression, anxiety, stress and in ameliorating the quality of life of participants.