Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials
Open accessAbstract
Objective: Impairment of mental well-being (anxiety, depression, stress) is common among people with multiple sclerosis (PwMS). Treatment options are limited, particularly for anxiety. The aim of this study was to update our previous systematic review (2014) and evaluate via meta-analysis the efficacy of mindfulness-based interventions (MBIs) for improving mental well-being in PwMS. Methods: Systematic searches for eligible randomised controlled trials (RCTs) were carried out in seven major databases (November 2017, July 2018), using medical subject headings and key words. Studies were screened, data extracted, quality appraised and analysed by two independent reviewers, using predefined criteria. Study quality was assessed using the Cochrane Collaboration risk of bias tool. Mental well-being was the primary outcome. Random effects model meta-analysis was performed, with effect size reported as standardised mean difference (SMD). Results: Twelve RCTs including 744 PwMS were eligible for inclusion in the systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Overall SMD for mental well-being (eight studies) was 0.40 (0.28–0.53), p<0.01, I 2=28%; against active comparators only (three studies) SMD was 0.17 (0.01–0.32), p<0.05, I 2=0%. Only three adverse events were reported. Conclusions: MBIs are effective at improving mental well-being in PwMS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness. PROSPERO registration number: CRD42018093171.
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Three meta-analyses of mindfulness-based intervention studies in multiple sclerosis conducted in 2019 and 2020 revealed a small to moderate effect on mental well-being.
“3 meta-analyses of MBI studies conducted in 2019 and 2020 in individuals with MS revealed a small to moderate effect on mental well-being59”
From Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review (2022) · cites this paper as [59]
The Abstract reports that this meta-analysis found an overall effect on mental well-being in people with MS (SMD 0.40), and the Summary of main findings describes MBIs as moderately effective. This paper is one meta-analysis; the cited passages do not establish the sentence’s claim that three meta-analyses conducted in 2019 and 2020 found such an effect. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAn additional review of feasibility, acceptability, and adherence of mindfulness-based interventions in multiple sclerosis, brain injury, and spinal cord injury would add to the existing literature and inform future intervention development and implementation.
“additional review of the feasibility and acceptability of MBIs and participant adherence with MBIs in these populations would add to the existing literature and serve to inform the development and implementation of future MBIs.”
From Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review (2022) · cites this paper as [59]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn neurological conditions like multiple sclerosis, mindfulness-based interventions have shown improvements in anxiety, depression, fatigue, and stress.
“MBIs have also been studied in neurological diseases such as multiple sclerosis, demonstrating improvement in anxiety, depression, fatigue, and stress levels (Ghielen et al., 2019; Hoogerwerf et al., 2017; Simpson et al., 2019).”
From Online Mindfulness-Based Cognitive Therapy for People with Parkinson’s Disease and Their Caregivers: a Pilot Study (2022) · cites this paper as Simpson et al., 2019
The ‘Effect of MBIs on mental wellbeing measures’ section reports improvements in anxiety, depression, and stress among people with multiple sclerosis. Fatigue is not an outcome in that meta-analysis; although the paper lists studies that measured fatigue, it does not report a pooled fatigue improvement. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSimpson et al. observed, from eight clinical trials, an effect of mindfulness-based intervention on mitigating depression and anxiety symptoms; a moderate effect on reducing stress from six clinical trials; and a small effect on alleviating fatigue from seven clinical trials.
“Simpson et al. (50) observed the effect of mindfulness-based intervention on mitigating the symptoms of depression and anxiety from eight clinical trials, moderate effect on reducing stress from six clinical trials, and small effect on alleviating fatigue from seven clinical trials.”
From The Effectiveness of Cognitive-Behavioral, Mindfulness and Acceptance and Commitment Therapies to Improving the Psychological Symptoms of Patients with Multiple Sclerosis in Iran (Systematic Review and Meta-analysis) (2022) · cites this paper as [50]
The 'Effect of MBIs on mental wellbeing measures' section (page not provided) reports benefits for anxiety and depression from eight studies each, and a moderate effect on stress from six studies. It does not report a pooled small effect on fatigue from seven trials; the fatigue part of the claim is unsupported by our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe present study's quantitative results related to MBI efficacy echo previous meta-analyses.
“The present study’s quantitative results related to MBI efficacy echo previous meta-analyses.59–61,117,118”
From Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review (2022) · cites this paper as [59]
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Mindfulness-Based Stress Reduction in Pre-symptomatic Genetic Frontotemporal Dementia: A Pilot Study
Poos, J. M., van den Berg, E., Papma, J. M., van der Tholen, F. C., Seelaar, H., Kaat, L. D., Kievit, J., Tibben, A., Swieten, J. C. V., & Jiskoot, L. C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.864391 · Cited by 13 · see citing works
Nag, N., Yang, X., Jelinek, G. A., Neate, S. L., & Simpson, S. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.103804 · Cited by 12 · see citing works
Self-citationLawrence, M., Davis, B., Amicis, L. D., Booth, J., Dickson, S., Dougall, N. J., Grealy, M., Jani, B., Maxwell, M., Parkinson, B., et al. (2023) · Healthcare · doi:10.3390/healthcare11030355 · Cited by 11 · see citing works
“53) [23], and in a range of settings from acute clinical settings to the wider community [24].”
Self-citationNot for everyone: Factors influencing who receives psychotherapy in people with multiple sclerosis
Freedman, D., Oh, J., & Feinstein, A. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.106245 · Cited by 9 · see citing works
Avest, M. M. T., Huijbers, M. J., Horjus, C. S., Römkens, T. E. H., Witteman, E. M., van Dop, W. A., Dresler, M., Donders, A. R. T., Dijkstra, G. D. H., Nissen, L. H. C., et al. (2025) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaf116 · Cited by 9 · see citing works
“The positive results on psychological distress align with available meta-analyses, including patients with somatic conditions, 35 such as multiple sclerosis 36 and cancer.”
Korupolu, R., Malik, A., Ratcliff, C., Robinson-Whelen, S., & Taylor, H. B. (2022) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2022.05.020 · Cited by 8 · see citing works
Chmiel, J., Kurpas, D., & Stępień–Słodkowska, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14020373 · Cited by 8 · see citing works
Komar, A., Dickson, K., Alavinia, M., Bruno, T. R., Bayley, M. T., Feinstein, A., Scandiffio, J., & Simpson, R. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1339851 · Cited by 8 · see citing works
Self-citationSimpson, R., Posa, S., Bruno, T. R., Simpson, S., Wasilewski, M. B., Robinson, L. R., Munce, S., Bayley, M. T., & Feinstein, A. (2022) · Journal of Neurology · doi:10.1007/s00415-022-11497-x · Cited by 8 · see citing works
“Unfortunately, effective mental health treatments for PwMS are limited, with current evidence favoring cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBIs) [7, 8].”
BackgroundSelf-citationFragkiadaki, E., Anagnostopoulos, F., & Triliva, S. (2023) · Counselling and Psychotherapy Research · doi:10.1002/capr.12615 · Cited by 7 · see citing works
Polick, C. S., Rubenstein, D., Shah, S., Beckham, J. C., Calhoun, P. S., & Noonan, D. (2023) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntad159 · Cited by 7 · see citing works
Validity and Reliability of the Turkish Version of the Mindful Eating Behavior Scale
Dinç, Ö., Yıldız, E. A., Okburan, G., & Büyüktuncer, Z. (2025) · Nutrients · doi:10.3390/nu17193083 · Cited by 6 · see citing works
“These interventions have also been shown to reduce symptoms of depression and/or anxiety [11] and enhance mental well-being [12].”
Lawrence, M., Davis, B., Clark, N. E., Booth, J., Donald, G., Dougall, N. J., Grealy, M., Jani, B., MacDonald, J., Mason, H., et al. (2024) · Pilot and Feasibility Studies · doi:10.1186/s40814-024-01545-w · Cited by 6 · see citing works
“MBSR is effective in the treatment of anxiety and depression in diverse clinical populations including multiple sclerosis and Parkinson’s disease [11, 12] and in a range of settings [13].”
BackgroundSelf-citationScandiffio, J., Langer, L. K., Senthilnathan, V., Feng, G., Sureshkumar, A., Bromberg, M., Babineau, J., Donkers, S. J., Knox, K. B., Bruno, T. R., et al. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13315-6 · Cited by 8 · see citing works
Self-citationMotolese, F., Stelitano, D., Lanzone, J., Albergo, G., Cruciani, A., Masciulli, C., Musumeci, G., Pilato, F., Rossi, M., Ribolsi, M., et al. (2023) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2023.104931 · Cited by 5 · see citing works
A Phenomenological Understanding of Aging “Well” With Multiple Sclerosis
Richardson, E. V., & Motl, R. W. (2025) · The Gerontologist · doi:10.1093/geront/gnaf072 · Cited by 3 · see citing works
“A focus on wellbeing among persons aging with MS is not a new venture, and research has highlighted this population generally values spirituality, physical wellness, and psychological health as key components to wellbeing (e.g., McAuley et al, 2007; Simpson et al., 2019).”
InfluentialLyons, J. N., Campese, S., Learmonth, Y. C., Metse, A. P., Kermode, A. G., Karahalios, A., & Marck, C. H. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-055796 · Cited by 3 · see citing works
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“Both approaches have been associated with improvement of wellbeing [11, 12], reduction of stress, anxiety, depression, fatigue and sleep disturbances [13–16], cognitive fatigue and depression [17].”
BackgroundPanagopoulou, Z., Artemiadis, A., Chrousos, G. P., Darviri, C., & Anagnostouli, M. C. (2021) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acab044 · Cited by 4 · see citing works
Giovannetti, A. M., Quintas, R., Maggiolo, S., & Quartuccio, M. E. (2024) · Disability and Rehabilitation · doi:10.1080/09638288.2023.2290690 · Cited by 2 · see citing works
“Three recent metanalyses demonstrated that MBIs hold benefit for PwMS, specifically in terms of stress, anxiety, depression [21], fatigue [22] and quality of life (particularly the mental health component) [23], with and effect size from small to moderate [21–23].”
Bahmani, B., Mehraban, S., Azkhosh, M., Khanjani, M. S., & Azimian, M. (2022) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-127590 · Cited by 2 · see citing works
Senthilnathan, V., Zahir, S., Simpson, R., Jaglal, S. B., Craven, B. C., Fetterly, M.-J., Perrier, L., & Munce, S. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-086287 · Cited by 2 · see citing works
Self-citationFeinstein, A., Bar‐Or, A., Benedict, R. H. B., Filippi, M., Freedman, D., Kever, A., Meza, C., & Rocca, M. A. (2025) · Brain · doi:10.1093/brain/awaf319 · Cited by 3 · see citing works
Psychiatrische Syndrome bei multipler Sklerose
Neyazi, A., Konen, F. F., Kesen, C., & Skripuletz, T. (2024) · DGNeurologie · doi:10.1007/s42451-024-00636-5 · Cited by 1 · see citing works
Liu, Y., Zhao, X., Luo, C., Chen, A. L., & Zeng, X. (2026) · PeerJ · doi:10.7717/peerj.20900 · Cited by 1 · see citing works
“…cognition and value-oriented behaviors, rather than directly targeting sleep physiology ( Hayes, 2019 ); however, mindfulness improves sleep quality indirectly by enhancing non-judgmental awareness of present-moment experiences, reducing rumination and pre-sleep anxiety ( Simpson et al., 2019 ).”
Psychotherapeutische Interventionen bei Personen mit Multipler Sklerose (MS)
Sauder, T., Keune, P. M., Schenk, T., & Hansen, S. (2024) · Zeitschrift für Neuropsychologie · doi:10.1024/1016-264x/a000398 · Cited by 1 · see citing works
Sureshkumar, A., Luong, D., Munce, S., Bayley, M. T., Kastner, M., Scandiffio, J., Lai, N., Feng, G., Oh, J., Furlan, A. D., et al. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2492312 · Cited by 2 · see citing works
“However, evidence to support effectiveness is limited as some of these pharmacological treatments exacerbate fatigue and cognitive difficulties [10,11].”
InfluentialSelf-citationTheJournal of Neurology, Neurosurgery and Psychiatrycentenary milestone award 2020
Kiernan, M. C. (2020) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2020-322976 · Cited by 1 · see citing works
Simpson, R., & Mercer, S. W. (2020) · SAGE Publications Ltd eBooks · doi:10.4135/9781529734508 · Cited by 1 · see citing works
Self-citationMotolese, F., Stelitano, D., Lanzone, J., Albergo, G., Cruciani, A., Masciulli, C., Musumeci, G., Pilato, F., Rossi, M., Ribolsi, M., et al. (2023) · doi:10.22541/au.168416824.49652226/v1 · Cited by 1 · see citing works
Nickchen, K. (2022) · Elsevier eBooks · doi:10.1016/b978-3-437-23031-8.00009-1
Lawrence, M., Davis, B., Clark, N. E., Booth, J., Donald, G., Dougall, N. J., Grealy, M., Jani, B., MacDonald, J., Mason, H., et al. (2023) · Research Square · doi:10.21203/rs.3.rs-3396574/v1
Self-citationLifetime stressors relate to invisible symptoms of multiple sclerosis
Polick, C. S., Braley, T. J., Ploutz-Snyder, R. J., Connell, C. M., Watson, A., & Stoddard, S. A. (2024) · Exploration of Neuroprotective Therapy · doi:10.37349/ent.2024.00077
Campese, S., Lyons, J. N., Learmonth, Y. C., Metse, A. P., Kermode, A. G., Marck, C. H., & Karahalios, A. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105763
Henning, A., & Muschalla, B. (2024) · Acta Neurologica Scandinavica · doi:10.1155/2024/6674418
A systematic review of Nature-based interventions for neurological disordersPreprint
Christian, K., Ahmed, N., Huckle, C., & Bashford, J. (2025) · medRxiv · doi:10.1101/2025.06.21.25330058
“It is noteworthy that mindfulness, which has proven its benefit in several neurological diseases, is likely to share an overlapping mechanism with many Nature-based interventions ( Prohaska and Matthias, 2023 , Simpson et al., 2019 , Lin et al., 2023 ).”
Giovannetti, A. M., Pöttgen, J., & Pakenham, K. I. (2025) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197525456.013.0015
Luong, D., Lee, T. J., Simpson, R., Fetterly, M.-J., Jaglal, S. B., Allin, S. J., Craven, C., Hearn, J. H., Webster, F., & Munce, S. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2580297
“Of note, MBIs have been shown to have a positive impact on individuals’ overall wellbeing in various other chronic illnesses such as multiple sclerosis and cancer [17–21].”
Self-citationThe impact of multiple sclerosis on parenting: a mixed-method systematic review
Dowd, E. S., & O’Keeffe, F. M. (2025) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2577266
“A review of mindfulness-based interventions (MBIs) for the mental wellbeing of people with MS by Simpson et al. [54] found MBIs moderately effective for treating anxiety, depression, and stress.”
LAWRENCE, M., Davis, B., Clark, N. E., Booth, J., Donald, G., Dougall, N. J., Grealy, M., Jani, B., MacDonald, J., Mason, H., et al. (2024) · Figshare · doi:10.6084/m9.figshare.27012285
Self-citationSimpson, S., Furlong, M., & Giebel, C. M. (2021) · Figshare · doi:10.6084/m9.figshare.17007084
Self-citationLAWRENCE, M., Davis, B., Clark, N. E., Booth, J., Donald, G., Dougall, N. J., Grealy, M., Jani, B., MacDonald, J., Mason, H., et al. (2024) · Figshare · doi:10.6084/m9.figshare.27012282
Self-citationLAWRENCE, M., Davis, B., Clark, N. E., Booth, J., Donald, G., Dougall, N. J., Grealy, M., Jani, B., MacDonald, J., Mason, H., et al. (2024) · Figshare · doi:10.6084/m9.figshare.27012291
Self-citationLAWRENCE, M., Davis, B., Clark, N. E., Booth, J., Donald, G., Dougall, N. J., Grealy, M., Jani, B., MacDonald, J., Mason, H., et al. (2024) · Figshare · doi:10.6084/m9.figshare.27012288
Self-citationSenthilnathan, V., Simpson, R., Jaglal, S. B., Craven, B. C., Fetterly, M.-J., Allin, S. J., Webster, F., Hearn, J. H., Luong, D., & Munce, S. E. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2612456
“Mindfulness-based interventions (MBIs) have shown promising results in improving mental health in people with neurological conditions such as multiple sclerosis [26,27], epilepsy [28] and stroke [29].”
Self-citationPagliari, C., Cabinio, M., & Blasi, V. (2026) · Springer eBooks · doi:10.1007/978-3-032-08980-9_21
A Unifying Framework of Meditation Techniques
Imriška, V. (2026) · Mindfulness · doi:10.1007/s12671-026-02758-1
Zeynali, N., Akbari, M., & Ghezelbash, S. (2026) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1661_24
“Since perceived stress indicates the mental evaluation of the amount of stressfulness in life situations, [33] it seems that the positive skill improvement program has strengthened positive thinking in patients suffering from heart failure and therefore, has decreased the level of their stress.”
yousefvand, M., & Ziyar, Z. (2025) · مجله علمی دانشگاه علوم پزشکی رفسنجان · doi:10.66224/jrums.24.8.709
Ward, L. O., Bailey, C., Wattanatakulchat, P., Stone, B., Bürger, A., Kaplan, D. M., Alvarez, S. J. A., Joyce, C., Eclair, A., Dam, N. T. V., et al. (2026) · JMIR Research Protocols · doi:10.2196/85110 · Cited by 1 · see citing works
Zhang, C., Scandiffio, J., Sureshkumar, A., Wasilewski, M. B., Donkers, S. J., Munce, S., & Simpson, R. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2026.2719953
Self-citationCaminero, A. B. (2026) · Journal of Personalized Medicine · doi:10.3390/jpm16100523
“Systematic-review evidence [80], an individual randomized trial [81], and subsequent meta-analytic or systematic syntheses [82,83] report benefits in stress, mood, coping or quality of life.”
- Authors
- Simpson, R., Simpson, S., Ramparsad, N., Lawrence, M., Booth, J., & Mercer, S. W.
- Affiliations
- University of Glasgow (GB)
- Glasgow Caledonian University (GB)
- Corresponding author
- Simpson, Robert
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2019-06-13
- Volume
- 90
- Issue
- 9
- Pages
- 1051-1058
- ISSN
- 0022-3050 (ISSN-L)
- 1468-330X
- OpenAlex
- W2949130233
- Semantic Scholar
- 78986ea7b28e29ddae980f60f28785d1b26b137e
- Cited by
- 86
- References
- 45
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 16 · 2023: 10 · 2022: 12 · 2021: 12 · 2020: 12 · 2019: 1
- FWCI
- 1.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- ResearchOnline (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Funders
- RS McDonald Trust
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- mindfulness-based interventions, multiple sclerosis, psychological well-being, anxiety, depression, stress, treatment efficacy, online delivery
- MeSH terms
- Emotional Adjustment, Humans, Multiple Sclerosis, Mindfulness
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