Meta-analyses suggest that mindfulness interventions have positive effects on mental health. Yet, how mindfulness interventions exert their effects is still largely unknown. Self-reported mindfulness may partially mediate the association between mindfulness interventions and change in self-reported mental health. We present the results of a novel application of three-level meta-analysis on the pre–post intervention data of 146 RCTs of mindfulness interventions (total N = 10,979), probing the efficacy of a broad range of mindfulness interventions and meditation training against active, treatment-as-usual (TAU), and wait-list control groups. We found that self-reported mindfulness not only increased in mindfulness interventions (d = 0.54, 95% CI [0.47, 0.61]), but also in active (nonmindfulness) controls (d = 0.27 [0.18, 0.36]) and wait-list controls (d = 0.10 [0.04, 0.17]; but not TAU controls: d = 0.04 [−0.03, 0.12]). In addition, change in mindfulness accounted for change in self-reported mental health (mindfulness interventions: d = 0.65 [0.57, 0.73]; active controls: d = 0.49 [0.36, 0.62]; TAU controls: d = 0.20 [0.12, 0.29]; wait-list controls: d = 0.22 [0.14, 0.30]) in all treatment and control groups alike. Thus, self-reported mindfulness apparently is no unique mediator of mindfulness interventions. It may either be more universal, merely a correlate of self-reported mental health, or both. Research should focus on the common denominator of mindfulness interventions and clinically relevant constructs with which self-reported mindfulness shares some of its characteristics. Limitations pertain to the indirect evidence of the three-level meta-analytic approach, the self-report nature of the data, and small-study effects, which suggest the presence of publication bias. The risk of bias may have led to the overestimation of effects and results could further be subjected to effects of shared method variance.

中文翻译：

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自我报告的正念解释了正念干预和非正念控制对自我报告的心理健康的影响：对 146 项随机对照试验的预注册系统评价和三级荟萃分析。

荟萃分析表明，正念干预对心理健康有积极影响。然而，正念干预如何发挥其效果仍然很大程度上是未知的。自我报告的正念可能部分调解正念干预与自我报告的心理健康变化之间的关联。我们对 146 项正念干预的随机对照试验（总 N = 10,979）的干预前后数据进行了三级荟萃分析的新应用结果，探讨了广泛的正念干预和冥想训练对积极干预的有效性、照常治疗 (TAU) 和等待名单对照组。我们发现自我报告的正念不仅在正念干预中增加（d = 0.54, 95% CI [0.47, 0.61]），而且在主动（非正念）控制中也增加了（d = 0.27 [0.18, 0. 36]）和等待名单控制（d = 0.10 [0.04, 0.17]；但不是 TAU 控制：d = 0.04 [-0.03, 0.12]）。此外，正念的变化解释了自我报告的心理健康的变化（正念干预：d = 0.65 [0.57, 0.73]；主动控制：d = 0.49 [0.36, 0.62]；TAU 对照：d = 0.20 [0.12, 0.29] ]；等待​​名单控制：d = 0.22 [0.14, 0.30]) 在所有治疗组和对照组中都一样。因此，自我报告的正念显然不是正念干预的唯一中介。它可能更普遍，只是与自我报告的心理健康相关，或两者兼而有之。研究应该集中在正念干预的共同点和临床相关的结构上，自我报告的正念与这些结构有一些共同的特征。限制与三级荟萃分析方法的间接证据有关，数据的自我报告性质和小型研究的影响，这表明存在发表偏倚。偏倚风险可能导致高估效果，结果可能进一步受到共享方法方差的影响。