Mindfulness and Objective Measures of Body Awareness: A Preregistered Systematic Review and Multilevel Meta-Analysis.

Objective: Bodily sensations are a key element in many mindfulness practices. Previous meta-analytic evidence indicated a small positive association between mindfulness and interoceptive accuracy. The current study aimed to critically extend and update these findings, using all currently available evidence.

Methods: Randomized controlled trials, case-control studies, and cross-sectional studies were identified in a systematic literature search and conjointly analyzed with three-level meta-analysis, using robust estimators. Further, comprehensive risk-of-bias assessment, publication bias tests, and moderator analysis were conducted.

Results: Across 41 studies and 112 extracted effect sizes (N=2411), there was a small positive association (r=0.13, P=0.002) between mindfulness and interoceptive accuracy, with an uninformatively wide 95% prediction interval [-0.36 to 0.62]. The effect was driven by indirect (vs. direct) measures of body awareness and case-control studies with long-term meditators. There was high heterogeneity, signs of publication bias, and predominantly low study quality, especially regarding the objectivity, validity, and reliability of implemented body awareness tasks.

Conclusions: The point estimate suggests a small positive association between mindfulness and interoceptive accuracy. However, there still is substantial uncertainty about the effect's true magnitude and even its direction. More high-quality research and standardization of body awareness tasks are needed. Further, the complexity and costs of body awareness tasks suggest only limited practical utility in applying them for the assessment of mindfulness. Given the known efficacy of mindfulness interventions for various physical and mental disorders, clarifying the association between mindfulness and subjective and objective body awareness could enhance clinical practices.