By ACE team

Photo credit: Shutterstock


  1. What is the question we are thinking about?

Stress is a natural physical and mental reaction to life experiences. But taken too far, all life’s stresses can impact on our mental health and sense of well being. We’ve all felt it. Anything from everyday responsibilities like work and family to serious life events such as a new diagnosis, war, or the death of a loved one can trigger stress. The level and extent of stress a person may feel depends a great deal on their attitude to a particular situation. We all deal with stress differently, sometimes stress can be a positive force, motivating you to rise to an occasion, for instance, perform well at your sports trial or job interview. But often it’s a negative force leaving one feeling overwhelmed.

  1. Why is this an important topic for citizens?

A Bloomberg study reports that South Africa is the second most-stressed country in the world. Mental health problems affect one in four South Africans – with only 15%–25% of affected individuals seeking and receiving help, as noted by Schoeman (2017). In the workplace, loss of earnings due to major depression and anxiety disorders are estimated at R54,121 per affected adult per year, resulting in a total annual cost to the South African economy that amounts to more than R40-billion, which is 2.2% of the country’s GDP (Schoeman, 2017). These alarming figures should and must be of concern to each and every citizen. We all have a role to play, a mandate in dealing with stress and mental health issues.

  1. What credible and appropriate evidence did we find, and what did it say?

So then, what is the most effective way to deal with stress and is there any evidence around this? One of the approaches one hears quite a lot about is to practice mindfulness to reduce stress. Mindfulness is “a skill to non-judgementally observe sensations, thoughts, emotions and the environment, while encouraging openness, curiosity and acceptance” (De Vibe et al., 2017). What evidence underlies mindfulness practice as helpful for stress reduction, or is it something that is being widely advocated but not evidence-based? Our starting point is always to look for any evidence synthesis on any given topic. Our evidence synthesis search lead us to the Campbell  Collaboration’s Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis. MBSR is a group-based health promotion intervention that is aimed at improving health and the way people deal with stress and life’s challenges. The key ingredient is mindfulness training through physical and mental exercises practiced daily for eight weeks (De Vibe et al., 2017). In this systematic review, 101 randomized controlled trials (RCTs) with 8,135 participants from Australia, the USA, Europe and Asia are summarised. The results are quite encouraging, MBSR is found to have a moderately large effect on outcome measures of mental health, physical health, and quality of life including social function. In context, if 100 people undergo the MBSR programme, 21 more people will have a favourable mental health outcome in comparison to being put on a wait-list or receiving only the usual treatment. Whilst MBSR has small effects on improving mental health at post-intervention, they are significant in that they have the same effect as other active interventions on physical health, and quality of life (De Vibe et al., 2017).

  1. How do the findings translate to the South African and/or African context?

As indicated above, the participants of the were mainly from Australia, the USA, Europe and Asia. However, this does not deter the ability of MBSR to be applicable to the South African context. After all, stress is a biological phenomenon that affects the South African and the general African populace the same way as it does any person from any part of the world.

  1. What are we as citizens to do next?

The first thing is to be aware and accept stress as a natural phenomenon that none of us, including our loved ones, are immune to. Second is the commitment to ensure that we invest time to understand how to handle stressful situations. We provide a brief description of MBSR based on the evidence and draw lessons from this review.

Description and lessons from the evidence:

MBSR spans over eight weeks with weekly mindfulness sessions of 2 to 2½ hours. If time is a limiting factor, the weekly sessions can be shortened to 30-90 minutes or fewer sessions of 4-7 weeks. The programme focuses on the development of acceptance and non-reactive attitudes to what one is experiencing in each moment. The core elements of MBSR are rooted in ancient Buddhist practices of Samatha (concentration) and Vipassana (insight) meditation and yoga exercises.

Hence, MBSR can be tailored to meet time needs and can be seen as a blend of popular stress handling methods. As citizens, we, no matter how small the issue is, can consider taking up MBSR to improve our health, quality of life and social functioning.

  1. How and where did we search, together with a confidence statement about what we found?

Our quest to searching for reliable evidence meant Campbell Collaboration’s working group of systematic reviews was our first point of contact. Luckily, we found evidence syntheses on our topic of interest, Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis.


References cited in this article

De Vibe, M. F., Bjørndal, A., Fattah, S., Dyrdal, G. M., Halland, E., & Tanner-Smith, E. E. (2017). Mindfulness-based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta-analysis. [Accessed July 6, 2018]

Schoeman, R. (2017, August 31). Mental health problems cost SA’s economy billions per year. Financial Mail. Retrieved from