How mindfulness-based training improves stress-related health: a selective review of randomized clinical trials comparing psychological mechanisms of action.
Lara M.c. Puhlmann, Veronika Engert
Frontiers in Endocrinology August 4, 2025 DOI: 10.3389/fendo.2025.1415081 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Selective review Randomized Peer reviewed |
|---|---|
| Interventions | Mindfulness-based interventions ReSource training program |
| Topics | Meditation |
| Keywords | Humans Stress, psychological Monitoring Cortisol Randomized controlled trials Acceptance Stress-related health Sympathetic-adrenomedullary system sam Training-specific effects |
| Key findings | The authors conclude that monitoring needs to be coupled with acceptance for beneficial effects on physiological stress activity during acute challenges, consistent with Monitor and Acceptance Theory. In basal states, monitoring alone can buffer physiological stress, particularly with longer practice, possibly by enabling other coping mechanisms such as social support. Subjective-psychological stress and affect showed either non-specific effects or were most affected by combined monitoring and acceptance. |
Abstract
Mindfulness-based interventions (MBIs) have been shown to reduce both subjective experiences and physiological markers of stress, a central pathway to improving health and wellbeing. Yet, understanding of the causal mechanism through which MBIs affect stress-related health outcomes remains poor. Most MBIs rely on training programs that simultaneously target multiple and distinct mental processes, hampering mechanistic conclusions. Addressing this shortcoming, the present selective review provides an overview of randomized controlled trials (RCTs) that directly contrast the effects of distinct components of mindfulness on stress-related health. We examine two comparative frameworks, the prominent Monitor and Acceptance Theory (MAT) and the ReSource training program, an intervention protocol designed to disentangle mindfulness components in a large-scale mental training project. We focus on how a) attention monitoring and b) experiential acceptance skills affect the stress-related outcomes assessed. These include subjective-psychological stress and affect, and physiological stress and stress-related health markers (e.g., activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and proinflammatory activity), each in two different states of the stress system: acutely stressful challenges and more long-term basal functioning. In line with MAT, we find that monitoring needs to be coupled with acceptance for beneficial effects on stress-related physiological activity in states of acute challenge. In basal states, however, physiological stress activity can be buffered by monitoring alone, especially if practiced for longer duration. We suggest that when dealing with basal longer-term stress, monitoring allows individuals to use coping mechanisms other than acceptance, such as social support. Subjective-psychological stress and affect were mostly assessed in basal states and show either non-specific effects after all types of training, or are most affected by combined monitoring and acceptance. Our work highlights the need to evaluate different training mechanisms in relation to stress-specific states (herein, basal versus challenge) and outcomes (herein, subjective-psychological versus physiological) in order to better understand mindfulness mechanisms of action.
Comparable studies
Other narrative reviews on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical populations | 2003 | Review | |
| Mindfulness: Theoretical Foundations and Evidence for its Salutary Effects | 2007 | Review | |
| Mindfulness Interventions | 2016 | Review | |
| Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation | 2017 | Review | |
| Mindfulness and acceptance: expanding the cognitive-behavioral tradition | 2005 | Review |
Citations in the library
Cited by 3
- Mindfulness and learning engagement among undergraduate dance majors: the serial mediating roles of self-efficacy and academic burnout Frontiers in Psychology September 1, 2026
- The effectiveness of mindfulness-based nursing management intervention programme on compassion fatigue, resilience, and social support among oncology nurses: a randomised controlled trial with mediating role of physiological biomarkers. BMC Nursing April 18, 2026
- Live Video MBSR is a Feasible and Acceptable Adjunctive Therapy for Youth With Inflammatory Bowel Disease. Global Advances in Integrative Medicine and Health 2025
Cites 39
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- Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation Perspectives on Psychological Science October 10, 2017
- What defines mindfulness-based programs? The warp and the weft Psychological Medicine December 29, 2016
- Mindfulness-based interventions: an overall review British Medical Bulletin April 21, 2021
and 34 more in the library