A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation
Open accessAbstract
Psychological stress is a major provocative factor of symptoms in chronic inflammatory conditions. In recent years, interest in addressing stress responsivity through meditation training in health-related domains has increased astoundingly, despite a paucity of evidence that reported benefits are specific to meditation practice. We designed the present study to rigorously compare an 8-week Mindfulness-Based Stress Reduction (MBSR) intervention to a well-matched active control intervention, the Health Enhancement Program (HEP) in ability to reduce psychological stress and experimentally-induced inflammation. The Trier Social Stress Test (TSST) was used to induce psychological stress and inflammation was produced using topical application of capsaicin cream to forearm skin. Immune and endocrine measures of inflammation and stress were collected both before and after MBSR training. Results show those randomized to MBSR and HEP training had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms. However, MBSR training resulted in a significantly smaller post-stress inflammatory response compared to HEP, despite equivalent levels of stress hormones. These results suggest behavioral interventions designed to reduce emotional reactivity may be of therapeutic benefit in chronic inflammatory conditions. Moreover, mindfulness practice, in particular, may be more efficacious in symptom relief than the well-being promoting activities cultivated in the HEP program.
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Other longitudinal RCTs showed no sustained attention differences between MBSR and HEP, comparable post-training stress-evoked cortisol responses, and equivalent reductions in self-reported psychological distress and physical symptoms.
“Other longitudinal Rcts also showed no sustained attention differences between MBsR and heP, MBsR and heP had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms (Davidson, 2010;Maccoon et al., 2012;2014;Rosenkranz et al., 2013).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Rosenkranz et al., 2013
The Results (Cortisol) report no significant MBSR–HEP difference in stress-evoked cortisol response, and the Discussion reports comparable reductions in psychological distress and medical symptoms. The Methods (Participants) say attention outcomes belonged to a larger set of experiments whose results would be reported elsewhere; this paper does not establish the claimed absence of sustained-attention differences. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLater rigorous RCT studies using an active control failed to replicate the positive results of meditation versus waitlist control.
“however, later rigorous Rct studies using an active control failed to replicate these results.”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Rosenkranz et al., 2013
The Methods (Interventions) describe random assignment to MBSR or an active control. The paper reports comparable reductions in psychological distress, consistent with no added benefit for that outcome, but the Results (Primary analyses: Effects of the intervention) find a significantly smaller post-training inflammatory flare in the MBSR group. It therefore does not support the unqualified claim that active-control studies failed to replicate positive results. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe waitlist control has been intensively investigated in the meditation field.
“the waitlist control has been intensively investigated in the meditation field (Davidson, 2010;Maccoon, Maclean, Davidson, saron, & lutz, 2014;Maccoon et al., 2012;Rosenkranz et al., 2013;terburg et al., 2009).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Rosenkranz et al., 2013
For the past 10 years, more and more meditation studies have used longitudinal RCT design with active controls such as relaxation training, health education or enhancement programs, physical exercise, and cognitive tasks.
“consequently, for the past 10 years, more and more meditation studies have used longitudinal Rct design with active controls such as relaxation training, health education or enhancement programs, physical exercise, and cognitive tasks (Davidson, 2010;Maccoon et al., 2012;2014;Rosenkranz et al., 2013;terburg et al., 2009).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Rosenkranz et al., 2013
A series of studies used MBSR versus HEP to validate the active control in meditation.
“For example, a series of studies used MBsR vs. health enhancement Program (heP) to validate the active control in meditation (Davidson, 2010;Maccoon et al., 2012;2014;Rosenkranz et al., 2013).”
From Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males (2024) · cites this paper as Rosenkranz et al., 2013
Mindfulness practices are associated with supporting physical health.
“Mindfulness practices have been associated with benefits for coping with stress, anxiety, and depression [23,25,26,27], improving compassion and increasing prosocial (e.g., helping or relationship-promoting) behaviors [28,29,30], bolstering attention and working (e.g., short-term) memory [31,32], improving self-regulatory abilities (e.g., self-control) [33], and supporting physical health [34,35,”
Although the HEP and mindfulness conditions were effective at improving mood, stress, and cognition, they did not significantly differ.
“Although the HEP and mindfulness conditions were effective at improving mood, stress, and cognition, they did not significantly differ.”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [95]
The mindfulness program was more effective at reducing inflammatory markers in response to a social stress test and pain.
“However, the mindfulness program was more effective at reducing inflammatory markers in response to a social stress test95 and pain.74”
From The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer (2019) · cites this paper as [95]
MBSR outperformed HEP in lowering inflammatory responses after social stress and in reducing experimentally induced pain ratings.
“However, the MBSR program was more effective at reducing inflammatory responses following social stress141 and experimentally-induced pain ratings.139”
From Mindfulness meditation-based pain relief: a mechanistic account (2016) · cites this paper as [141]
Mindfulness training has a specific effect on a broad range of affective and physical health outcomes, as indicated by studies that controlled for nonspecific factors or lacked group support.
“Still, there is evidence that mindfulness training studies that either control for these factors or lack these intervention elements (e.g., group support) have been linked with affective and physical health outcomes (e.g., Kabat-Zinn et al., 1998; Polusny et al., 2015; Rosenkranz et al., 2013; Taren et al., 2015), suggesting a mindfulness-specific impact on a broad array of outcomes.”
From Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT (2017) · cites this paper as Rosenkranz et al., 2013
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Flagged first, then by citations
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The Neuroscience of Mindfulness Meditation
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Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT
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“…factors or lack these intervention elements (e.g., group support) have been linked with affective and physical health outcomes (e.g., Kabat-Zinn et al., 1998; Polusny et al., 2015; Rosenkranz et al., 2013; Taren et al., 2015), suggesting a mindfulness-specific impact on a broad array of outcomes.”
BackgroundConceptual and methodological issues in research on mindfulness and meditation.
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Self-citationBiological and psychological markers of stress in humans: Focus on the Trier Social Stress Test
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“In addition, the diurnal slope of cortisol responses was steeper in the MBSR compared with HEP groups after training, a pattern associated with improved cognitive and psychological functioning (Rosenkranz et al., 2013).”
BackgroundResultMindfulness meditation and the immune system: a systematic review of randomized controlled trials
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How Does Mindfulness Training Affect Health? A Mindfulness Stress Buffering Account
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Mindfulness Meditation and Psychopathology
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Creswell, J. D., Taren, A. A., Lindsay, E. K., Greco, C. M., Gianaros, P. J., Fairgrieve, A., Marsland, A. L., Brown, K. W., Way, B. M., Rosen, R. K., et al. (2016) · Biological Psychiatry · doi:10.1016/j.biopsych.2016.01.008 · Cited by 299 · see citing works
Mindfulness meditation-based pain relief: a mechanistic account
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Prospects for a clinical science of mindfulness-based intervention
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Rapid changes in histone deacetylases and inflammatory gene expression in expert meditators
Kaliman, P., Álvarez-López, M. J., Cosín-Tomás, M., Rosenkranz, M. A., Lutz, A., & Davidson, R. J. (2014) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2013.11.004 · Cited by 300 · see citing works
Self-citationThe Effects of Mind-Body Therapies on the Immune System: Meta-Analysis
Morgan, N., Irwin, M. R., Chung, M., & Wang, C. (2014) · PLoS ONE · doi:10.1371/journal.pone.0100903 · Cited by 294 · see citing works
“For IL-8, three studies [36,45,63,65] with a total of 158 participants were identified.”
BackgroundCahn, B. R., Goodman, M. S., Peterson, C. T., Maturi, R., & Mills, P. J. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00315 · Cited by 292 · see citing works
Mindfulness Training and Physical Health: Mechanisms and Outcomes
Creswell, J. D., Lindsay, E. K., Villalba, D. K., & Chin, B. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000675 · Cited by 252 · see citing works
“For example, one methodologically strong trial showed that mindfulness training buffered stress-induced inflammatory responses in the skin (43).”
Lindsay, E. K., Chin, B., Greco, C. M., Young, S., Brown, K. W., Wright, A. G. C., Smyth, J. M., Burkett, D., & Creswell, J. D. (2018) · Journal of Personality and Social Psychology · doi:10.1037/pspa0000134 · Cited by 218 · see citing works
“…although there is ample evidence that mindfulness interventions can reduce negative affect (for reviews, see Keng et al., 2011; Khoury et al., 2013), some questions remain about whether mindfulness programs are more effective than active placebo controlled programs (e.g., Rosenkranz et al., 2013).”
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Self-compassion as a predictor of interleukin-6 response to acute psychosocial stress
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Goldberg, S. B., Wielgosz, J., Dahl, C., Schuyler, B., MacCoon, D. S., Rosenkranz, M., Lutz, A., Sebranek, C. A., & Davidson, R. J. (2016) · Psychological Assessment · doi:10.1037/pas0000233 · Cited by 172 · see citing works
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Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis
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Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial
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Mindfulness-based stress reduction for long-term physical conditions: a systematic review.
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“Although for Rosenkranz et al. (2013) the average SE was first calculated across the 5 measures.”
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Brief Mindfulness Meditation Induces Gray Matter Changes in a Brain Hub.
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“As such, altering our maladaptive stress responses, such as in chronic or uncontrolled stress, via stress reduction techniques can have downstream benefits for both physical (Rosenkranz et al., 2013) and psychological (Britton et al., 2012) well-being.”
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“…has been intensively investigated in the meditation field (Davidson, 2010; Maccoon, Maclean, Davidson, saron, & lutz, 2014; Maccoon et al., 2012; Rosenkranz et al., 2013; terburg et al., 2009). early meditation research often used meditation intervention vs. waitlist control and demonstrated…”
InfluentialDeconstructing the relationship between mindfulness and leader effectiveness
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“The significant within-subjects effects observed for psychological outcomes suggest gradual improvements in response to MM exposures with changes similar to those found in prior studies of MM and psychological status (Oman et al., 2008; Rosenkranz et al., 2013; Tang et al., 2007).”
ResultJuul, L., Pallesen, K. J., Piet, J., Parsons, C., & Fjorback, L. O. (2018) · Mindfulness · doi:10.1007/s12671-017-0873-0 · Cited by 22 · see citing works
“…in brain regions involved in how we respond to negative and/or stressful events (Davidson et al. 2003; Farb et al. 2013), changes in associated somatic measures including immune function (Davidson et al. 2003; Rosenkranz et al. 2013) and blood pressure (Hughes et al. 2013; Nyklicek et al. 2013).”
BackgroundPlasma oxytocin is modulated by mental training, but does not mediate its stress-buffering effect
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Specific reduction in the cortisol awakening response after socio-affective mental training
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Mindfulness-Based Stress Reduction and Transcendental Meditation: Current State of Research
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- Authors
- Rosenkranz, M. A., Davidson, R. J., MacCoon, D. G., Sheridan, J. F., Kalin, N. H., & Lutz, A.
- Affiliations
- University of Wisconsin–Madison (US)
- The Ohio State University (US)
- Venue
- Brain, Behavior, and Immunity
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 27
- Issue
- 1
- Pages
- 174-184
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC3518553
- OpenAlex
- W2133206720
- Cited by
- 307
- References
- 93
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 12 · 2023: 33 · 2022: 20 · 2021: 30 · 2020: 19 · 2019: 27 · 2018: 23 · 2017: 26 · 2016: 26 · 2015: 27 · 2014: 24 · 2013: 9
- FWCI
- 21.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01at002114-03)
- National Institute of Mental Health (P50MH069315)
- National Center for Complementary and Alternative Medicine
- National Center for Complementary and Integrative Health (U01-AT002114, P01AT004952, U01AT002114-01A1)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (P30HD003352)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Keywords
- mindfulness-based stress reduction, neurogenic inflammation, psychological stress, meditation training, Trier Social Stress Test, cortisol response, psychological distress, chronic inflammatory diseases
- MeSH terms
- Adult, Analysis of Variance, Blister, Capsaicin, Female, Humans, Hydrocortisone, Male, Middle Aged, Saliva, Stress, Psychological, Tumor Necrosis Factor-alpha, Interleukin-8, Treatment Outcome, Sensory System Agents, Meditation, Neurogenic Inflammation, Mind-Body Therapies, Young Adult, Self Report
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