Systematically Reviewing The Efficacy of Mindfulness-Based Interventions For Enhanced Athletic Performance

Journal of Clinical Sport Psychology, 2015, 9, 232 -262
http://dx.doi.org/10.1123/jcsp.2014-0017
© 2015 Human Kinetics, Inc. ORIGINAL RESEARCH
Systematically Reviewing the Efficacy

of Mindfulness-Based Interventions for
Enhanced Athletic Performance
Ryan Sappington and Kathryn Longshore
Temple University
The field of applied sport psychology has traditionally grounded its performance
enhancement techniques in the cognitive-behavioral elements of psychological
skills training. These interventions typically advocate for controlling one’s cognitive
and emotional processes during performance. Mindfulness-based approaches, on
the other hand, have recently been introduced and employed more frequently in an
effort to encourage athletes to adopt a nonjudgmental acceptance of all thoughts
and emotions. Like many applied interventions in sport psychology, however,
the body of literature supporting the efficacy of mindfulness-based approaches
for performance enhancement is limited, and few efforts have been made to draw
evidence-based conclusions from the existing research. The current paper had the
purpose of systematically reviewing research on mindfulness-based interventions
with athletes to assess (a) the efficacy of these approaches in enhancing sport
performance and (b) the methodological quality of research conducted thus far.
A comprehensive search of relevant databases, including peer-reviewed and gray
literature, yielded 19 total trials (six case studies, two qualitative studies, seven
nonrandomized trials, and four randomized trials) in accordance with the inclusion
criteria. An assessment tool was used to score studies on the quality of research
methodology. While a review of this literature yielded preliminary support for the
efficacy of mindfulness-based performance enhancement strategies, the body of
research also shows a need for more methodologically rigorous trials.
Keywords: mindfulness, applied sport psychology, systematic review
“The development and ultimate credibility of sport psychology will be

influenced by its degree of success in responding to standards of scientific and
public accountability” (Smith, 1989, p. 166).
To better ensure the quality of services provided by sport psychologists
or ‘performance enhancement consultants,’ the field of sport and performance
psychology must remain in constant pursuit of evidentiary support for the efficacy of
Ryan Sappington and Kathryn Longshore are with the Department of Kinesiology at Temple University
in Philadelphia, PA. Address author correspondence to Ryan Sappington at rsappington@temple.edu.
232
Efficacy of Mindfulness-Based Interventions 233
its interventions (Smith, 1989). While other fields consistently generate systematic
reviews of the body of research on various practices, sport psychology very rarely
engages in such rigorous evaluation of intervention efficacy. As such, the present
paper sought to systematically review a particular sport psychology intervention
for the purpose of upholding practices in applied sport psychology to the highest
“standards of scientific . . . accountability” (Smith, 1989, p. 166).
Although its practices are diverse and multifaceted, applied sport psychology
is focused primarily on enhancing the performance and well-being of athletes in
their sports. A significant component of this work concerns interventions directed at
building effective emotional management skills during competition, which includes
coping with performance anxiety. Elevated performance anxiety and emotional
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mismanagement are commonly linked to performance decrements and other

deleterious consequences (Hanin, 1995; Hardy, Jones, & Gould, 1997; Woodman
& Hardy, 2001). The physiological and behavioral responses characterizing
performance anxiety are typically a result of extremely high levels of emotional,
psychological, and/or physiological arousal, combined with patterns of disruptive
thinking and negative self-talk, such as “What if I miss? What if I let everyone
down?” (Hatzigeorgiadis & Biddle, 2008; Woodman & Hardy, 2001). Clearly, this
is a multifaceted issue for which sport psychologists have worked to understand
and devise interventions to solve.
One of the more prominent models used by performance enhancement
consultants has, historically, been the traditional Psychological Skills Training
(PST) model. PST works to provide athletes with skills (i.e., goal setting, imagery,
self-talk, relaxation) that increase focus and control arousal or combat maladaptive
psychological processes believed to disrupt performance (Hardy et al., 1997). This
traditional approach to performance enhancement is largely based on the assumptions
and principles of cognitive behavioral therapy (Whelan, Mahoney, & Meyers, 1991).
These practices have been questioned on the grounds that they posit that athletes
can and should control internal processes, such as emotional, psychological, and
physiological functioning, to achieve optimal performance (Moore, 2009). Often,
within the scope of traditional PST, the focus is on manipulating perceived negative,
unpleasant, or dysfunctional thoughts or feelings. Criticisms of this model suggest
that while there is a wealth of research on PST techniques and various outcome
variables (e.g., confidence or anxiety), unfortunately, much of this research has not
been able to show definitive and consistent evidence of PST’s effectiveness (Birrer
& Morgan, 2010; Gardner & Moore, 2004; Moore, 2009). Importantly, Gardner
and Moore (2004) discuss a potentially paradoxical effect of PST, such that athletes
experience increased negative cognitions and emotions, due to meta-cognitive
scanning and monitoring. Consequently, controlling mental processes in this way
may take valuable mental energy and focus away from the task at hand (Gardner
& Moore, 2012). Finally, PST interventions tend to focus entirely on competitive
behaviors rather than the athlete as a person and their subsequent total well-being
(Gardner & Moore, 2007).
Alternatively, a relatively new approach to performance enhancement
includes mindfulness and acceptance-based interventions, such as Mindful
Sport Performance Enhancement (MSPE; Kaufman, Glass, & Arnkoff, 2009)
and Mindfulness Acceptance Commitment (MAC; Gardner & Moore, 2007).
Mindfulness-based interventions have garnered an increasingly established
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234 Sappington and Longshore
credibility in clinical and health psychology contexts (Grossman, Niemann,

Schmidt, & Walach, 2004; Hofmann, Sawyer, Witt, & Oh, 2010), yet until quite
recently, had not been introduced to sport and performance (Gardner & Moore,
2004). These interventions were first applied to athletes, partially in response to
the significant limitations of PST explained above.
Mindfulness practices, seek to “promote a modified relationship with internal
experiences . . . rather than seeking to change [them]” (Gardner & Moore,
2012, p. 309). In other words, rather than attempt to control or ignore internal
processes as in PST, individuals are encouraged to acknowledge and accept
them as simply events in the ebb and flow of competition (Gardner & Moore,
2007; Kaufman et al., 2009). Mindfulness training ultimately strives to instill a

nonjudgmental awareness of such cognitions, acknowledgment, and acceptance
in their emergence, and gradually (through extensive practice), the shifting of
one’s focus and attention back to the task-at-hand (without actively controlling
or changing the thought process).
The nonjudgmental orientation toward thoughts and emotions is an important
element of this approach, because it emphasizes that so-called “negative”
psychological processes do not necessarily hinder an individual’s well-being (or
an athlete’s performance). Rather, a person’s labeling of “negative” and subsequent
reaction to the psychological process determines its effect (Hayes, Strosahl,
& Wilson, 1999). Furthermore, mindfulness reinforces the idea that there is a
natural ebb and flow of “positive” and “negative” internal experience. This further
reinforces the notion that nothing is permanent and one’s experience can change in
the next moment (Kabat-Zinn, 2003). Thus, contrary to the traditional cognitive-
behavioral practices of actively controlling thoughts and emotions, mindfulness
and acceptance-based interventions are geared toward enhancing psychological
flexibility. Gardner and Moore (2012) noted the manner in which mindfulness-
based therapies for athletes might potentially address the limitations inherent in
traditional performance enhancement approaches:
[The mindfulness] models suggest that optimal performance does not require
the reduction or volitional control of internal states at all, but rather, requires (a)
a nonjudging (i.e., not good, not bad, not right, not wrong) moment-to-moment
awareness and acceptance of one’s internal state, whatever that may be; (b) an
attentional focus on task-relevant external stimuli, instead of a focus on internal
processes that includes judgment and direct efforts at control/modulation; and
(c) a consistent and effortful personal values-driven commitment to behavioral
actions/ choices that support one’s athletic endeavor (p. 309).
The relationship between mindfulness-based interventions and anxiety has, in
large part, been well-documented in the clinical literature (Baer, 2003; Grossman
et al., 2004; Chiesa & Serretti, 2009; Hofmann et al., 2010). Mindfulness-based
interventions seek to increase one’s tolerance of anxiety, thereby altering one’s
relationship to anxiety, and alleviating some of the suffering associated with
experiencing anxiety (Brown & Ryan, 2004). Furthermore, rather than reducing
anxiety, mindfulness models merely encourage a change in one’s approach and
orientation toward cognitions and somatic experiences, such as anxiety. In this
sense, controlling or reducing anxiety, for example, in athletes is not the ideal
JCSP Vol. 9, No. 3, 2015

goal, as PST suggests (Moore, 2009). Instead, mindfulness-based performance

enhancement attempts to alter one’s interpretation of, or relationship with, internal
processes (Kaufman et al., 2009; Moore, 2009).
Mindfulness-Based Training Approaches

Mindfulness and acceptance-based interventions have been used in various forms
across clinical practice, including Mindfulness-Based Stress Reduction (MBSR;
Kabat-Zinn, 1990; 2003), Mindfulness Based Cognitive Therapy (MBCT; Segal,
Williams, & Teasdale, 2002; Teasdale, Segal, & Williams, 2003), and Acceptance-
Commitment Therapy (ACT; Hayes et al., 1999). In athletic contexts and more
recent work, the fundamentals of these models have been integrated into MAC
(Gardner & Moore, 2007; see Appendix A for a summary of the MAC protocol)
and MSPE (Kaufman et al., 2009). The theory behind and concepts of mindfulness
taught in each of these models is relatively consistent, the difference lying mainly
in application. For example, the MAC approach draws on ACT, incorporating
brief meditations, while also focusing on goal-directed behavior and values. In
contrast, MSPE draws on the MBSR format and relies heavily on different medita-
tion practices, placing emphasis on somatic awareness and mindful movement. In
addition, the MAC approach is geared toward individual athletes or performers,
while the MSPE approach is suitable for groups. Finally, the typical length of the
program in an MSPE approach is four sessions meeting (usually) weekly that are
2.5–3 hr in duration, which is different from that of the MAC protocol. The MAC
protocol includes seven flexible modules, which typically span 8–12 weeks, and
are 1-hr sessions.
The review that follows, examining mindfulness-based therapies with athletes,
considers all approaches while focusing primarily on ACT, MAC, and MSPE, as
these were the most common methods noted in the literature. However, due to the
relatively recent nature of these approaches in sport, there have also been a few
studies applying a mindfulness-based intervention outside of these protocols (see
Aherne et al., 2011; Baltzell, Caraballo, Chipman, & Hayden, 2014).
Objectives
The application of mindfulness-based interventions in sport is relatively new
(Gardner & Moore, 2007) and the pool of research is considerably small. With this
in mind, the current review considered both randomized and nonrandomized trials, in
an effort to more comprehensively evaluate the efficacy of mindfulness interventions
and consider limitations in the empirical evidence. Gardner and Moore (2012)
provide a similar review of mindfulness research with athletes. The current paper
expands on their discussion and reinforces their conclusions on the following two
levels: (1) Gardner and Moore’s (2012) paper was not systematic in nature, leaving
room for this systematic review to provide a detailed account of a standardized
literature search process, as well as formally evaluate the methodological quality of
mindfulness intervention research with athletes via a quality assessment tool; and
(2) the current paper includes any research that was not discussed in the previous
review and studies that have since been published, providing a comprehensive and
JCSP Vol. 9, No. 3, 2015

up-to-date account of mindfulness interventions in sport. Given the noted gaps in

literature and an alarmingly small pool of evidentiary support for mindfulness-based
therapy with athletes, the current systematic review has two primary objectives: (1)
to evaluate the efficacy of mindfulness-based therapy as a performance enhancement
intervention for athletes and (2) to evaluate the methodological quality of the
research conducted thus far on mindfulness interventions in sport.
Method
The review of empirical literature on mindfulness and athletic performance was
divided into three distinct subsets of the research, each of which consists of trials
that are progressively more rigorous in nature, and (presumably) increasing in
methodological quality. Due to the relatively novel nature of the topic/intervention,
both nonrandomized and randomized trials were included into the search process,
assessment, and discussion. The quality assessment tool used in this review was
developed from three commonly used checklists for evaluating quantitative research
(see discussion of quality assessment checklist below). The tool was used to evaluate
randomized and nonrandomized trials; however, it was not applied to the first subset
of research (case studies), as these trials were largely qualitative.
Literature Search Process

The search process conducted in the present review examined the following
databases from October 2013 through February 2014 (a follow-up search was
conducted again in January 2015): SPORTDiscuss (with Full Text); Ovid MEDLINE
(Ovid Medline (R) In-Process & Other Non-Indexed Citations and Ovid Medline
(R); all EBM Reviews-Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR,
HTA, and NHSEED; Ovid Healthstar; PsycINFO); Health and Psychosocial
Instruments; PsycINFO; and Google Scholar. The search also investigated gray
literature which included related reviews, bibliographies, and unpublished trials
(dissertations and theses).
Various combinations of the following search terms were used in the database
search process: Mindful*; Acceptance and Commitment Therapy; ACT; Psycho-
logical Skills; Athlet*; Sport*; Perform*; Competit* Anxiety; Perform* Anxiety;
and Random*. The search results included all trials that met the following criteria:
English articles (including those translated to English); samples comprised solely
of sport participants or athletes (of any level); the experimental use of mindfulness-
based intervention techniques to enhance performance in athletes; the use of ran-
domization in group assignment (nonrandomized trials were subsequently added
into the review); findings from both published and gray literature; and samples
made up of any ethnicity, gender, and sport. Articles were excluded from the final
search results if the following applied: (1) They solely explored trait mindful-
ness (as opposed to applied mindfulness interventions); (2) used a mindfulness
intervention in conjunction with another intervention (such that it was difficult to
discern the clear impact of mindfulness-based interventions); (3) employed samples
consisting of nonathletes; or (4) were published in non-English journals (or lacked
an English translation).
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Outcomes of Interest
The outcomes of interest in the current review were all related directly or indirectly
to athletic performance. The most common dependent variables discussed across
the literature included: objective measures of performance (e.g., national rank,
placement in competition, performance scores); subjective measures of performance
(e.g., postgame self- and coach-ratings); measures of competitive state anxiety;
validated measures of mindfulness (increased awareness and nonjudgmental
acceptance); and the psychological experience of “flow” (Csikszentmihalyi, 1990).
Flow has been described as a temporary psychological state of optimal experience,
brought on when an individual’s skill level is appropriate for a challenge. The
resulting experience is characterized by high levels of engagement, absorption,

and enjoyment in a present task, independent of extrinsic reward or incentive
(Csikszentmihalyi, 1990; Nakamura & Csikszentmihalyi, 2002, 2009). Flow
was included in the pool of outcome variables considered in this review, because
extensive research (Jackson, Thomas, Marsh, & Smethurst, 2001; Stavrou, Jackson,
Zervas, & Karteroliotis, 2007; Bakker, Oerlemans, Demerouti, Slot, & Ali, 2011;
etc.) has linked the flow experience to high levels of performance in various domains.
As the present review is concerned solely with athletic performance, studies failing
to include a performance-related outcome were not reviewed.
The empirical studies included in this review were evaluated for methodological
quality via a carefully developed quality assessment tool. Due to the small number
of trials, conclusions regarding the effectiveness of mindfulness-based interventions
were drawn based on a synthesis of subjective and objective measurements of
performance across the randomized and nonrandomized trials.
Assessment of Methodological Quality

The quality assessment checklist developed for this systematic review combined
features of three widely used tools for evaluating the methodological quality of
empirical research in the fields of public health or health care interventions: the
Downs and Black (1998) checklist, the CONSORT checklist (Schulz, Altman,
& Moher, 2010), and the Child Care and Early Education Research Connections
(CCEERC) quantitative research assessment tool. Various items pulled from each
of these three assessment scales were deemed comprehensive enough to assess a
relatively new intervention and research field with sufficient depth (see Appendix
B for a version of the checklist used in this review).
Removing duplicates, 23 items from the Downs and Black (1998) and
CONSORT (Schulz et al., 2010) checklists were deemed sufficient for the current
review. One of these items was slightly altered (“Description of retention for
follow-up or explanation provided for participants lost before follow-up”). The
following three items were ultimately added to the initial pool of 23 to sufficiently
address points outlined specifically in the CCEERC quantitative assessment tool,
bringing the total number of assessment items to 26:
1. Alternate/Distractor task employed for control/comparison group
2. At least 65% of selected sample completed the study
3. Random selection was used
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All responses to the items were standardized (“yes” or “no”) and quantified
(“1” = “yes” and “0” = “no”). The values were added up for each study across the
quality assessment criteria to yield a “Total Score.” The maximum possible score
on this quality assessment was 26. Since previously used checklists were combined
and modified to apply to the current review, it was reasonable to create a new
classification system on which to categorize the quality of the individual studies:
10 or fewer: very poor quality
11–13: poor quality
14–16: fair quality
17–19: good quality
20–22: very good quality

23–26: excellent quality
Results
The original screening process identified all randomized trials in the empirical
literature. As shown in Figure 1, the 758 articles originally identified through various
sources (databases, gray literature, correspondence with leading researchers, etc.)
were reduced to 566 upon the removal of duplicates. Initial screening of titles and
Figure 1 — PRISMA diagram of search and screening process.

*Other trials included case studies, qualitative research, and nonrandomized open trials.
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abstracts yielded a further reduction to 108 articles, as 458 were excluded on varying
grounds of irrelevance (e.g., research samples of nonathletes, research outcomes
that were not performance-related, etc.). The 108 articles were then screened more
thoroughly, and 104 were excluded for various reasons, including but not limited
to, failure to use randomization, nonexperimental studies (lacking an intervention),
and non-English manuscripts (e.g., Justo, 2010). Articles originally published in
a different language and subsequently translated to English were included in this
review. This ultimately yielded several unforeseen issues with quality assessment for
one particular randomized trial (Moghadam, Sayadi, Samimifar, & Moharer, 2013).
Finally, studies employing a mindfulness-based intervention used in conjunction
with another intervention (e.g., Goodman, Kashdan, Mallard, & Schumann, 2014)
were also excluded, on the grounds that there was no way of ensuring that results
were due to mindfulness or another manipulation.
The four remaining articles constituted the subset of research articles
categorized as “Randomized Trials.” The 104 articles excluded in the second phase
of screening were examined further for potential relevance, and 15 of them (six
case studies, two qualitative studies, and seven nonrandomized open trials) were
included in the present systematic review to provide additional research evidence
and discussion, as well as a larger pool of studies to be qualitatively assessed.
This systematic review evaluated, and synthesized the findings from, 19 empirical
studies in total.
The assessment of each subset of the research (case studies, qualitative
research, nonrandomized open trials, and randomized controlled trials) is provided
and discussed below.
Case Studies
The literature search yielded six case studies in articles by Gardner and Moore
(2004), Lutkenhouse (2007), Schwanhausser (2009), and Bernier, Thienot, Pelosse,
and Fournier (2014). Each case study is summarized in Table 1. As evident in the
table, the age and sport participation of the six clients varied considerably.
Across these six cases, numerous potential benefits associated with mindfulness
training are demonstrated. Subjective (self- and coach-ratings) and objective
measures of performance, as well as psychological processes contributing to
performance, were all higher in postintervention assessment. Use of the MAC
protocol with athletes (see Lutkenhouse, 2007; Schwanhausser, 2009; and
Gardner & Moore, 2004) led to increases in objective and subjective measures
of performance, as well as increases in training intensity, flow, acceptance,
nonjudgmental awareness, and positive self-perceptions, along with decreases in
worry. Results from both case studies outlined in an article by Bernier et al. (2014)
showed differing outcomes depending on the extent to which an individual engaged
fully with the mindfulness protocol.
Findings across these case studies provide preliminary evidence for the
efficacy of mindfulness interventions for boosting performance-related outcomes
on an individual level. Furthermore, they also show that these outcomes can vary
depending on how committed an individual is to practicing the mindfulness program.
In addition, the case studies varied in age, gender, and sport, providing further
support for the efficacy of mindfulness interventions across a range of samples.
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Table 1 Case Studies on Mindfulness Training for Enhanced Athletic
Performance
Case Background Intervention Results
“Jenny” • 19, Caucasian female • 7-session MAC • Coach-ratings
Division 1 lacrosse player protocol • Self-ratings
• Performance dysfunction • objective: address • Improvement in self-
• “Pessimistic, lack of subclinical issues perceptions (motivation,
motivation, self-doubts” fitness, performance, etc.)
“Steve” • 12, Caucasian male, • 7-session MAC • Increase in experiential
high-level springboard protocol acceptance and
and platform diving nonjudgmental awareness
• Referred by coach • Increase in flow, diving

to maximize diving performance
performance
• Motivated, optimistic,
competitive
“DG” • 22, male intercollegiate • 12-week MAC • Self-reported reductions
swimmer protocol in worry, increases in
• Often underperforms, • Nonathletic enjoyment
recommended by coach mindfulness, • Increases in coach-
• “Worrier” breathing mindfulness, and self-reports of
preperformance performance
mindfulness
“LD” • 37, female power lifter, • MAC protocol • Increase in self-reported
previous world champion training intensity
• Plateau in progress • Increase in objective
• “Unfocused” performance
“Sarah” • 13, an elite French • 11-month mindfulness- • Increase in objective

female figure skater based intervention from measures of performance
• Ranked in top 3 MBCT and ACT • Highly motivated to
nationally • Objective: use practice mindfulness
• Competitive anxiety mindfulness skills (adhered to study protocol)
(somatic and cognitive to optimize attention • Developed mindfulness
symptoms) regulation skills
“Lise” • 12, an elite French • 11-month mindfulness- • Participant failed to fully
female figure skater based intervention from engage in program
• Ranked in top 3 MBCT and ACT • Smaller increases in
nationally • Objective: use objective measures of
• Anxiety, fear of making mindfulness skills performance
mistakes to optimize attention • Lack of satisfaction with
regulation competition scores
• Lack of motivation in
practicing mindfulness,
lack of understanding
Note. “Jenny”: Lutkenhouse (2007); “Steve”: Schwanhausser (2009); “DG” and “LD”: Gardner and Moore
(2004); “Sarah” and “Lise”: Bernier et al. (2014).
240 JCSP Vol. 9, No. 3, 2015

The effective application of mindfulness in a wide range of athletic contexts was a

consistent theme across the research. Both randomized trials and nonrandomized
trials (see Tables 3 and 7) further demonstrated that mindfulness interventions
could be easily delivered to a variety of athletes, levels, and activities. This mirrors
conclusions from the general mindfulness literature, such that mindfulness-based
interventions have been applied to diverse populations, including clinical and
healthy people, with consistent success (Baer, 2003, Chiesa & Serretti, 2009;
Hofmann et al., 2010).
While the observable impact of mindfulness training in a case study setting
is evident, the limitations of case study research must also be acknowledged.
Creswell (2011) explains that while case studies are useful for describing real-
life phenomenon, conclusions may be too narrow to be generalized to a wider

population. Furthermore, one may not be able to reliably establish cause or effect
due to the failure to use comparative or control groups. Finally, the impact of
experimenter bias or expectancy effects—particularly in interpreting the data—
needs to be considered.
Qualitative Research
The literature search process also identified two recent qualitative studies on the
effects of mindfulness interventions with athletes. While neither study permitted
the use of the quality assessment tool (due to their being qualitative in nature),
the results build on those derived from the aforementioned case studies and
provide additional evidence of the impact of mindfulness-based interventions on
performance. The first study, a non-peer-reviewed doctoral dissertation, examined
the efficacy of individualized mindfulness practices with five female equestrian
athletes (ages 13–18), using interviews and narrative inquiry analysis (Wicks,
2012). The study was distinctive because each participant largely designed her own
mindfulness practice, based on individual needs. Some of the main elements of their
practices included focus, breathing, body scans, visualization, and meditation, and
most of the practices seemed to be loosely based on the MAC protocol (Gardner
& Moore, 2007).
Wick’s (2012) interviews identified numerous themes related to the positive
impact of mindfulness practice on equestrian athlete performance. Participant
responses included increased engagement in performance; athletes’ perceptions of
deeper, more effective relationships with the horses (i.e., achieving a stronger bond,
being “in sync”); high prevalence of the experience of flow and flow-like symptoms;
increased focus and sense of calm during competition; sense of purposefulness/
intentionality in performance; increased positivity and ability to overcome mistakes
or setbacks; reduced stress levels; increased awareness; and even improvements in
objective performance measurements (i.e., competition results).
The second qualitative study (Baltzell et al., 2014) discussed the self-reported
experiences of seven members of a Division I women’s soccer team who participated
in 12 sessions (for a duration of 6 weeks) of a “mindfulness meditation training for
sport (MMTS)” program. The MMTS program designed by Baltzell and colleagues
(2014), focused on fostering nonjudgmental awareness, compassion, concentration,
and acceptance of negative mind-states, and included both breathing and imagery
exercises. After all 19 players had completed the 6-week intervention, seven of
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them volunteered to participate in semistructured interviews designed to assess

their experiences. Postintervention interview results indicated that, before the
intervention, all seven athletes reported feeling significant pressure and demands
in their athletic participation. Concerning the impact of the intervention, athletes
noted improved focus on the field, recognition of, and enhanced relationships
with, emotions on and off the field, and an increased appreciation for the benefits
of mindfulness meditation. Finally, the athletes were asked to provide feedback on
the MMTS program, and they recommended further efforts to relate mindfulness to
sport and real-life scenarios, changing the timing of program administration (i.e.,
meditate before practice rather than after), and extending the length of the program
as a whole (Baltzell et al., 2014).
One of the unmentioned limitations of this study concerned the fact that only
postintervention measurement was conducted. While the participants discussed
“initial attitudes, general emotional states, and behaviors [they] experienced . . .
before starting the MMTS intervention,” these responses were collected after the
athletes had completed the program, and these “baseline” reports could have been
influenced by their exposure to the intervention (Baltzell et al., 2014, p. 226).
Nonrandomized Trials
The third subset of empirical research incorporated into the present review included
quantitative nonrandomized trials that evaluated the efficacy of mindfulness-based
training approaches on enhanced athletic performance. Seven nonrandomized open
trials on mindfulness interventions with athletes were identified from the literature
search. The decision to apply the quality assessment tool to the nonrandomized trials
was made, in large part, to compare methodological elements of the randomized
and nonrandomized research in this particular field. The quality assessment of the
nonrandomized trials is displayed in Table 2.
Despite the absence of randomization across these trials, the total scores for
all seven nonrandomized trials were adequate, ranging from 16–20 (denoting “Fair
Quality” and “Very Good Quality”). Tables 3–5 summarize demographic and
intervention characteristics, as well as results, of the seven nonrandomized trials.
Table 5 indicates that, while both De Petrillo, Kaufman, Glass, & Arnkoff (2009)
and Kaufman et al., (2009) conducted MSPE workshops, neither found significant
effects on objective measures of performance. However, when a follow-up study
was conducted (Thompson, Kaufman, De Petrillo, Glass, & Arnkoff, 2011) using
the samples drawn from the same pools of participants, the long-distance runners
in De Petrillo’s et al. (2009) research noted significant improvements in their mile-
times. These findings lend support to the notion that mindfulness training may be
more effective for performance if the practice is sustained over a longer period of
time (Kaufman et al., 2009).
The nonrandomized trials yielded results (Table 5) similar to those of the
aforementioned case studies, further indicating that mindfulness-based interventions
may be effective tools for improving performance in athletes. Mindfulness-based
interventions were shown to relate to improved (subjective and objective) measures
of performance (Bernier, Thienot, Codron, & Fournier, 2009; Thompson et al.,
2011; Wolanin, 2004), increases in mindfulness skills and experiential acceptance
(Hasker, 2010), decreases in competitive anxiety and perfectionism (De Petrillo
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Table 2 Quality Assessment of Nonrandomized Trials

Bernier De Kaufman Kettunen
Wolanin et al. Petrillo et et al. Hasker Thompson & Välimäki
Quality Assessment Items (2004) (2009) al. (2009) (2009) (2010) et al. (2011)* (2014)**
Sufficient introduction/background provided to
1 1 1 1 l 1 1
explain rationale for study
Hypothesis/aim/objective is clearly described 1 1 1 1 1 1 1
Random selection was used 0 0 0 0 0 0 0
Random assignment was used 0 0 0 0 0 0 0
Participants were representative of the entire
0 0 0 0 0 0 0
population from which they were recruited
Outcome variables described 0 1 1 1 1 1 1
Participant eligibility criteria included 1 0 1 1 1 1 1
Participants’ demographic information included 1 1 1 1 1 1 1
Groups equal at baseline 0 0 1 1 0 1 1
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Interventions adequately described 1 1 1 1 1 1 1
Dates of the study reported 0 0 0 0 0 0 0
Consistent time period between intervention and
1 1 1 1 1 1 1
outcome for control/intervention groups
Adherence to study protocol 1 1 1 1 1 1 1
Sample sizes were adequate (at least 25 per group) 0 0 0 0 0 0 1
Sample sizes were adequate for subgroup analyses 0 0 0 0 0 0 1
Alternate/distractor task employed for control/
0 1 0 0 1 0 0
comparison group
243
(continued)
244
Table 2 (continued)
Bernier De Kaufman Kettunen
Wolanin et al. Petrillo et et al. Hasker Thompson & Välimäki
Quality Assessment Items (2004) (2009) al. (2009) (2009) (2010) et al. (2011)* (2014)**
At least 65% of selected sample completed the
1 1 1 1 1 0 1
study
Description of retention for follow-up or
explanation provided for participants lost before 1 1 1 1 1 1 1
follow-up
Intention-to-treat analysis followed 1 1 0 0 1 1 0
Appropriate statistical tests were used 1 1 1 1 1 1 1
Main results clearly described 1 1 1 1 1 1 1
Main outcome(s) was measured correctly 1 1 1 1 1 1 1
Means. SD/SE, CI, effect sizes reported 1 0 0 0 1 0 1
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Actual probability values were reported 0 0 0 0 0 1 1
Study limitations described 1 1 1 1 1 1 1
Conclusions provided 1 1 1 1 1 1 1
Total Quality Score 16 16 16 16 18 17 20
Good Good Fair Fair Good Very Good
Good Quality
Quality Quality Quality Quality Quality Quality
Note. Items in BOLD denote areas of noteworthy weakness in general research methodology. *Thompson et al. (2011): Follow-up, using samples from Kaufman
et al. (2009) and De Petrillo et al. (2009). **Kettunen and Välimäki (2014) is a master’s thesis, and at the time of this review, the study has not been published in a
peer-reviewed journal.
Table 3 Research (Demographic) Characteristics of Nonrandomized Trials

Study Sample Size Sport Participation Gender Age
Wolanin (2004) N = 20 Division I college athletes: volleyball 100% female 18–22
and field hockey (college freshmen–seniors)
Bernier et al. (2009) N = 7 (13)* Elite golfers 71.4% male M = 15.67
28.6% female SD = 0.74
De Petrillo et al. (2009) N = 25 Recreational long-distance runners 60% male M = 34.73
40% female
Kaufman et al. (2009) N = 32 Recreational archers and golfers 71.9% male M = 52.19
28.1% female
Hasker (2010) N = 19 Division II college athletes: 57.9% male M = 19.4
basketball, baseball, lacrosse, soccer, 42.1% female
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track and field, golf
Thompson et al. (2011) N = 25 Archers, golfers, runners 56% male M = 48.28
(participants from Kaufman et al., 44% female
2009 and De Petrillo et al., 2009)
Kettunen and Välimäki (2014)** N = 15 Female national league floorball 100% female 15–38 (M = 21.8)
players (Finland)
Note. *Bernier et al. (2009) compared the sample of seven elite golfers to a control group of six golfers from another training center. ** Kettunen and Välimäki (2014)
is a master’s thesis, and at the time of this review the study had not been published in a peer-reviewed journal.
245
246
Table 4 Interventions Employed in Nonrandomized Trials
Study Intervention
Wolanin (2004) Intervention (n = 13): 7-session MAC protocol (Gardner & Moore, 2007)
Control (n = 7): No treatment
Bernier et al. (2009) Intervention (n = 7): Mindfulness education program, using Mindfulness Based Cognitive Therapy
(MBCT) and Acceptance Commitment Therapy (ACT) was added to a preexisting Psychological Skills
Training (PST) program
Control (n = 6): Received the preexisting PST program (no mindfulness)
De Petrillo et al. (2009) Intervention (n = 25): 4-week workshop (2.5–3 hr sessions): Mindful Sport Performance Enhancement
(MSPE); practiced mindfulness exercises and logged running performance between sessions
Control: No control group/condition = change measured over 4-week workshop
Kaufman et al. (2009) Intervention (n = 32): 4-week workshop (2.5–3 hr sessions): MSPE; practiced mindfulness exercises and
logged sport performance between sessions
Control: No control group/condition = change measured over 4-week workshop
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Hasker (2010) Intervention (2 groups): 7-session MAC protocol (Gardner & Moore, 2007); 1 hr per week
Control (2 groups): 7-session US Olympic Mental training (MT) program; 1 hr per week
Thompson et al. (2011) Follow-up study: One year following completion of MSPE workshops; used combined samples and data
from De Petrillo et al. (2009) and Kaufman et al. (2009)
Kettunen and Välimäki (2014)** Intervention (n = 25): Based on Acceptance-Commitment Therapy, and modified for sports; six sessions,
with mindfulness exercises assigned as homework
Control (n = 24): No treatment or intervention
Note. *Kettunen and Välimäki (2014) is a master’s thesis, and at the time of this review the study had not been published in a peer-reviewed journal.
Table 5 Results/Findings from Nonrandomized Trials

Study Outcome(s) of Interest Results
Wolanin (2004) • Compare impact of Mindfulness- • Greater increases in coach ratings of performance for MAC group
Acceptance-Commitment (MAC) treatment (37%) than control group (14%)
with control group with no intervention on • Presence or absence of subclinical psychological issues might
athletic performance moderate impact of MAC intervention (MAC might work best
for athletes who are not dealing with psychological issues beyond
performance development)
Bernier et al. (2009) • Compare effects of Mindfulness program • Improved national ranking for all mindfulness group golfers
with those of Psychological Skills Program • Qualitative reports via interviews showed strong understanding of
mindfulness, self-perceptions of enhanced performance, and high
satisfaction with program
• Higher “activation” scores for golfers in mindfulness group (p <
.03)
De Petrillo et al. (2009) • Examined effects of Mindful Sport • No group differences on performance or other outcome variables,
Performance Enhancement on long-distance with the exception of fewer organizational demands reported by
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runners; compare with no intervention intervention group postprogram
control group • Pre- to postworkshop improvements in sport anxiety related
worry and dimensions of perfectionism
Kaufman et al. (2009) • Impact of Mindful Sport Performance • No changes in performance pre- to postworkshop
Enhancement (MSPE) on flow, performance, • Increased levels of flow associated with increased mindfulness (r
and psychological characteristics = .67, p < .01)
• Significant changes in some trait variables (increased
mindfulness, dispositional optimism in archers)
(continued)
247
248
Table 5 (continued)
Hasker (2010) • Compare effectiveness of Mindfulness- • No significant differences in coach- and self-ratings of
Acceptance- Commitment (MAC) approach performance for MAC vs. MT groups
vs. traditional Mental Skills Training (MT) • MT group showed greater improvement in self-ratings over time
approach in enhancing athletic performance
• MAC group showed increased mindfulness skills, increased
experiential acceptance
Thompson et al. (2011) • Follow-up investigation on long-term • Long-distance runners showed significant improvement in mile
effects of Mindful Sport Performance time from pretest (M = 7.36) and post-test (M = 7.28) to follow-up
Enhancement program on athletic (M = 6.54)
performance
Kettunen and Välimäki • Coach evaluation of player performance • ACT-based intervention had no significant effect on athlete
(2014)* well-being, self-ratings of performance, or coach-ratings of
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performance, compared with control group
• Athlete self-evaluation of performance • Increase in self-ratings of performance associated both with
increase in mindfulness skills and increase in self-confidence in
intervention group
• Self-reported measure of self-confidence • Majority of athletes in intervention group (17/25) reported
gaining “new methods to handle anxiety/stress”
Note. *Kettunen and Välimäki (2014) is a master’s thesis, and at the time of this review the study had not been published in a peer-reviewed journal.
et al., 2009; Kaufman et al., 2009), increases in flow experiences (Kaufman et al.,
2009), and increases in self-confidence (Kettunen & Välimäki, 2014).
Kettunen and Välimäki (2014) measured the impact of an ACT-based
intervention on several measures of athlete well-being and self-rated performance,
yet failed to find a significant effect. However, when the sample was divided in
half and researchers analyzed participants in the lower half of all measurements
(e.g., low self-confidence, low performance, etc.), results indicated that the
intervention had a significant positive impact on self-confidence for those in the
lower half of the sample. While the trial was an unpublished (non-peer-reviewed)
master’s thesis, Kettunen and Välimäki’s (2014) study also included a qualitative
measurement of athlete feedback, indicating that most athletes in the intervention
group perceived that they gained better coping skills for stress and anxiety as a
result of the intervention.
Limitations in Nonrandomized Open Trial Research

The most notable weakness in these seven trials was the lack of randomization in
study design. It should be noted that some of the authors (De Petrillo et al., 2009;
Kaufman et al., 2009) discussed the intention, originally, to use random assignment
and failed to follow through due to scheduling issues with the participant pools.
Nevertheless, the lack of randomization across all seven trials raises concerns over
the conclusions drawn.
Several of the individual trials exhibited additional limitations in their approach
and methodology. Wolanin (2004), for example, noted that “Assignment to groups
was based on participant’s interest in engaging in a performance enhancement
intervention” (p. 17), introducing the likelihood that individual motivation and
interest impacted the extent to which the MAC group exhibited improvements
in performance. Furthermore, Hasker (2010) noted that the 19 participants were
divided into four groups (two per condition), yet failed to note specifically how
many individuals were in each group.
Randomized Trials
A summary of the quality assessment of the four randomized trials in this review
can be found in Table 6.
Total scores of quality assessment for the four randomized trials ranged
considerably from 13–22 (“Poor Quality” to “Very Good Quality”). Summaries
of demographic characteristics, intervention protocols, and results can be found
in Tables 7–9.
Moghadam et al. (2013) examined the impact of a mindfulness education pro-
gram on competitive state anxiety and enhanced sport performance in a sample of 40
professional badminton players in the Iranian Premier League. The trial examined
an all-male sample. The age range of the sample was merely labeled as ‘adult.’
Participants were randomly assigned to either experimental or control conditions,
whereby the experimental group received “mindfulness techniques education.”
Results suggested that posttest levels of competitive anxiety were significantly less
for the mindfulness (experimental) group than the control group (M = 27.6, M = 33.3
respectively). The posttest performance measurements were significantly higher for
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250
Table 6 Quality Assessment of Randomized Trials
Moghadam et al. Quinones-Paredes
Quality Assessment Items Aherne et al. (2011) John et al. (2011) (2013) (2014)*
Sufficient introduction/background provided to
1 1 1 1
explain rationale for study
Hypothesis/aim/objective is clearly described 1 1 1 1
Random selection was used 1 1 0 0
Random assignment was used 1 1 1 1
Participants were representative of the entire
1 1 0 0
population from which they were recruited
Outcome variables described 1 1 1 1
Participant eligibility criteria included 1 1 1 1
Participants’ demographic information included 1 1 0 1
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Groups equal at baseline 1 1 1 1
Interventions adequately described 1 1 0 1
Dates of the study reported 0 0 0 0
Consistent time period between intervention and
1 1 0 1
outcome for control/intervention groups
Adherence to study protocol 1 1 0 0
Sample sizes were adequate (at least 25 per
0 1 0 0
group)
Sample sizes were adequate for subgroup analy-
0 1 0 0
ses
Alternate/Distractor task employed for con-

0 0 0 1
trol/comparison group
At least 65% of selected sample completed the
1 1 1 0
study
Description of retention for follow-up or
explanation provided for participants lost before 1 0 0 1
follow-up
Intention-to-treat analysis followed 1 1 0 0
Appropriate statistical tests were used 1 1 1 1
Main results clearly described 1 1 0 1
Main outcome(s) was measured correctly 1 1 1 1
Means, SD/SE, CI, effect sizes reported 1 1 1 1
Actual probability values were reported 1 0 1 1
Study limitations described 1 0 1 1
Conclusions provided 1 1 1 1
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Total Quality Score 22 21 13 18
Very Good Quality Very Good Quality Poor Quality Good Quality
Note. Items in BOLD denote areas of noteworthy weakness in general research methodology. *Quinones-Paredes (2014) is a master’s thesis, and at the time of this
review the study had not been published in a peer-reviewed journal.
251
Table 7 Research (Demographic) Characteristics of Randomized Trials
Sample Gender Age
Study Size (N) Sport Participation Distribution Range
Aherne et al. Irish Collegiate Level
19–25
(2011) Rugby, tennis, hammer 69.2% Male
N = 13 (M = 21,
throw, running, field 30.8% Female
SD = 1.68)
hockey, hurdling
John et al. Elite level shooters
M = 29.5
(2011) N = 96 (selected from national 100% Male
SD = 4.3
shooting team)
Moghadam et al. Iranian Premier League

N = 40 100% Male ‘Adult’
(2013) Badminton
Quinones-Paredes 19–24
N = 13 College soccer players 100% Female
(2014)* (M = 21.5)
Note. *Quinones-Paredes (2014) is a master’s thesis, and at the time of this review the study had not
been published in a peer-reviewed journal.
Table 8 Interventions Employed in Randomized Trials

Study Intervention
Aherne et al. Intervention/experimental group (n = 6): Mindfulness training (6
(2011) weeks, Kabat-Zinn CD, a guided, self-directed program)
Control group (n = 7): No additional instruction; no contact during
intervention group training
John et al. Intervention/experimental group (n = 48): Mindfulness Medita-
(2011) tion Therapy (MMT)—4 weeks, 6 days per week, 20 min per day
(sessions of eight or fewer participants); intervention consisted
of mindfulness meditation exercises, including body scanning,
focused breathing, and “Shavasana’’ and “Pranayama” yoga poses
Control group (n = 48): No information provided on alternate/
distractor task
Moghadam et al. Intervention/experimental group (n = 20): Mindfulness techniques
(2013) education (authors failed to explain nature or duration of this inter-
vention)
Control group (n = 20): No information provided on alternate/
distractor task
Quinones-Paredes Intervention/experimental group (n = 8): 4-week Mindfulness Med-
(2014)* itation protocol (adapted for sport and delivered through audio file)
Comparison group (n = 5): Benson’s Relaxation Response (audio
file; 4 weeks)
Control group (n = 2): Attention control group (audio file with
relaxation music; 4 weeks) The control group was removed from
further analysis due to low participation.
252 JCSP Vol. 9, No. 3, 2015

Table 9 Results/Findings from Randomized Trials

Aherne et al. • Flow experiences (Flow • No significant global flow differ-
(2011) State Scale) ence at baseline, large difference at
follow-up training session (interven-
tion: 151.00, control: 131.6)
• Cognitive-Affective • Significant differences in posttest
Mindfulness Flow subscales (clear goals, sense
of control)—higher for Intervention
group
• Significant differences in Cognitive-

Affective Mindfulness scores (p <
.05)—higher for intervention
John et al. • Precompetition anxiety • Significant decrease in salivary
(2011) measured through salivary cortisol levels for Mindfulness
cortisol (physiological Meditation Therapy (MMT) group at
indicator of stress/anxiety) posttest and follow-up measurements
(i.e., indicator of decreased precom-
petition anxiety)
• Performance (shoot- • Significant increase in shooting
ing accuracy or shooting performance for MMT group
score) • Significant increase in salivary cor-
tisol levels for control group
Moghadam et al. • Effect of mindfulness • Posttest competitive anxiety levels
(2013) training on competitive significantly less for experimental
state anxiety and increased group than control group (27.6, 33.3
sport performance (five respectively); increased with control
games scored for individ- group
ual performance regardless • Posttest performance means sig-
of outcome) nificantly higher for experimental
group than control group (47.0, 43.7
respectively)
• Intervention explained 37% of the
variance in sport performance
Quinones-Paredes • Two measures of trait • No significant differences between
(2014)* mindfulness (Mindfulness experimental and comparison groups
Inventory for Sport and on any of the outcomes of interest
Mindful Attention Aware-
ness Scale)
• Dispositional Flow (Dis-
positional Flow Scale)
• Intention to suppress
unwanted thoughts and
sensations (White Bear
Suppression Inventory)
JCSP Vol. 9, No. 3, 2015 253

the experimental group than the control group, and the intervention was shown to
account for 37% of the variance in sport performance. However, the study’s authors
failed to provide an explanation of the nature or duration of the intervention in the
published manuscript. This undermines conclusions one can draw from this paper,
as there are no means to compare this intervention with others used in research.
Perhaps due to errors in translation (the original version of the article was pub-
lished in a non-English journal), the quality of Moghadam’s et al. (2013) research
was “Poor,” according to its assessment score. The study used a small sample size
(N = 40)—though it was relatively large compared with similar trials. The quality
rating of the study (see Table 6) was low largely due to the authors’ omission of
various details concerning the methodology and results. The article failed to include
sufficient detail concerning the sample demographics, procedure and intervention,

control group, measurement and data analysis, important statistical evidence (i.e.,
means, standard deviations, and effect sizes), and interpretation of results.
Despite numerous methodological flaws (and a “Poor Quality” score on the
assessment tool), Moghadam’s et al. (2013) study did contribute in unique ways
to the research on mindfulness interventions with athletes. Rather than rely on
self-reported measures of performance (like most other trials discussed in this
review), the researchers employed an objective rating of performance (five scored
badminton matches).
Studies by Aherne, Moran, and Lonsdale (2011) and John, Verma, and Khanna
(2011) exhibited the highest quality assessment scores across the entire review (22
and 21, respectively, out of 26—“Very Good Quality”). Aherne et al., (2011) con-
ducted a trial examining the efficacy of mindfulness training on collegiate athletes
in an Irish university. While the sport involvement was, again, diverse (rugby, tennis,
hammer throw, running, field hockey, and hurdling), Aherne et al. (2011) incorpo-
rated the second smallest sample size of all reviewed research (N = 13). This sample
was randomly selected from a population of 200 athletes from a high performance
institute in the university. The participants ranged from 19–25 years of age.
The 13 participants were randomly assigned to either the experimental inter-
vention group or the control group. The experimental group (n = 6) were provided
with a detailed and extensive mindfulness training program. Participants in this
group were provided with an informational handout on the history and theory
behind mindfulness in general and in sport. The program used four different exer-
cises across 6 weeks. The treatment was self-guided with instructional/educational
videos on mindfulness featuring Jon Kabat-Zinn. The authors noted that the control
group received no treatment and was, in fact, not contacted at any point during the
experimental group’s treatment.
Aherne et al. (2011) reported full retention of the participants from pretreatment
to posttreatment measurements. The study was one of the few of its kind to provide
an in-depth summary of the intervention protocol used with the experimental group.
While failing to incorporate a treatment condition for the control group, the study
avoided using a sample of athletes who were already receiving therapy or sport
psychology services. As such, the sample was not necessarily composed of athletes
experiencing “trouble” with their performance. For future research on mindfulness
and other sport psychology interventions, this should be a recommended practice,
as results would more clearly reflect the independent efficacy of one intervention.
Results from Aherne et al. (2011) indicated significant differences between the
JCSP Vol. 9, No. 3, 2015

experimental (M = 151.00) and control groups (M = 131.57) on Global Flow in

follow-up measurements (p < .05, d = 1.66), as well as significant differences on
several subscales or dimensions of flow. Results also demonstrated that the experi-
mental group experienced significant increases in Global Flow between pre- and
postintervention measurements, while the control group did not. Finally, results
showed a significant difference in cognitive-affective measures of mindfulness.
In an unpublished master’s thesis, Quinones-Paredes (2014) also used a
small sample size (N = 13), comprised wholly of female soccer players. The study
employed its own “Mindfulness Meditation Protocol in Sport” intervention, and
compared an experimental group (n = 8) to a “relaxation” group (n = 5). Results
failed to replicate those by Aherne et al., (2011), showing no significant differ-
ences between the groups on measures of flow and thought suppression. However,
the study noted several limitations in design and procedure, including the lack of
adherence of its participants to the intervention protocol.
John et al., (2011) assessed the impact of Mindfulness Meditation Therapy
(MMT) on precompetition anxiety (measured through salivary cortisol) and per-
formance, in an all-male sample of 96 elite shooters. The experimental group (n
= 48) was exposed to 24 sessions of mindfulness meditation exercises (including
body scanning, focused breathing, and “Shavasana” and “Pranayama” yoga poses).
Results indicated significant drops in salivary cortisol levels (indicator of anxiety)
and significant increases in shooting performance for the experimental group when
compared with the control group, at both posttest and follow-up measurements.
Overview on Randomized Trials

With the addition of randomization in the study protocol, the four randomized
trials exhibited several noteworthy strengths. Demographic diversity across the four
randomized trials was similar to that found in qualitative, nonrandomized trials,
and case study research. There was, again, commendable variability in the nature
of sport participation in each sample, suggesting that mindfulness can be used in
a wide range of sport contexts.
It is worth noting, however, that the body of randomized research showed room
for methodological improvements. With the exception of John et al. (2011), sample
sizes were small, and three out of the four randomized trials (Aherne et al., 2011;
John et al., 2011; Moghadam et al., 2013) failed to incorporate a distraction task
or treatment for the control group, introducing the potential impact of confounding
factors such as mere attention paid to an athlete (Aherne et al., 2011).
Discussion
Results from the limited number of randomized trials conducted thus far on
mindfulness-based practices with athletes have suggested that these interventions
can have benefits for sport performance. Furthermore, other forms of research, such
as case studies, qualitative methods, and quantitative nonrandomized trials, have
helped to substantiate these findings. However, in the interest of enhancing the
credibility of mindfulness-based practices and other interventions (Smith, 1989),
the field of sport psychology is in need of further research (of a more scientifically
rigorous nature) supporting their efficacy.
JCSP Vol. 9, No. 3, 2015

Results across the four randomized trials assessed in this review indicated
that mindfulness interventions contribute to improvements in objective measures
of performance (John et al., 2011; Moghadam et al., 2013), and outcomes related
to better performance such as flow (Aherne et al., 2011) or competitive anxiety
(John et al., 2011; Moghadam et al., 2013). Combined with the evidence from
qualitative research, nonrandomized open trials, and preliminary support offered
by case studies, mindfulness-based interventions also show promise as being
effective in improving performance and characteristics associated with well-being
(e.g., psychological flexibility, anxiety, flow). This is consistent with the findings of
Gardner & Moore’s (2012) review of the MAC approach. However, many of these
results should be examined further, given the lack of rigor and empirical quality
of the research thus far.

Upon review, it was evident that both Aherne et al. (2011) and John et al. (2011)
provided the closest approximations to a gold standard of empirical research among
the trials (randomized and nonrandomized) collected. Yet, while results suggest
that mindfulness training is effective in decreasing markers of precompetition
anxiety, while increasing flow, cognitive-affective measures of mindfulness, and
performance, both studies are vulnerable to limitation through a lack of control
group treatment.
General Limitations
Overall, the body of research is limited largely in its reliance on nonrandomized
approaches. Further subtle issues (identified even among randomized trials) point to
a lack of quality in the research efforts directed at this particular sport psychology
intervention. Several other limitations should be acknowledged when considering
the results of this systematic review: (1) Performance is difficult to measure directly
and objectively, and it is even more difficult to attribute enhanced performance to
one, or even a few, select variables; and (2) The apparent difficulty in obtaining
sufficiently large sample sizes is a significant hindrance to this field of research,
as it is very difficult to employ randomization with small samples.
Future Directions
The current review suggests that research on mindfulness training for athletes
must undergo a dramatic shift toward more methodologically rigorous empirical
testing. In their study on Mindfulness Meditation Therapy (MMT), John et al.
(2011) identified similar concerns, noting that: “ . . . many studies on MMT have
been criticized for the lack of scientific rigor, including the lack of high quality
randomized controlled studies…” (p. 16). With the exception of Aherne et al. (2011)
and John et al. (2011), a majority of the trials discussed in this review seemingly
fell well short of standards of methodologically strong research, in allowing for
numerous biases to potentially distort the research findings. The use of larger sample
sizes and randomization (of both selection processes and group assignment) must
both become priorities for this vein of sport psychology research. Our review of this
research also noted significant variability in the interventions used in employing
mindfulness-based practices with athletes. Such variability further limits the extent
to which conclusions can be compared and synthesized across trials. While Gardner
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and Moore (2007) have published a manual for the MAC approach, there is a need
to pursue similar manualization for meditation-based techniques (e.g., MSPE or
MMTS) as well. While Kaufman et al. (2009) developed a manual for MSPE, it
has not yet been made available for public use.
Furthermore, the field would benefit from studies of longer duration (Thompson
et al., 2011), consisting of longer treatment periods, longitudinal designs, and mul-
tidimensional, multiphase follow-up assessments, aimed at evaluating the long-term
impact of this particular intervention on performance. In addition, Wolanin (2004)
noted that subclinical issues might serve as a potential moderator impacting the
effectiveness of mindfulness programs. As such, and consistent with observations
put forth by Wicks (2012), athletes should not be treated as homogeneous and the
importance of pretherapy diagnoses must be acknowledged. The impact of both
subclinical issues, as well as personality in general could potentially present a
valuable opportunity for research in this field.
Conclusion
Based on a systematic analysis of 19 empirical trials (six case studies, two qualita-
tive studies, seven nonrandomized trials, and four randomized trials), the current
review provides preliminary support for the efficacy of mindfulness-based interven-
tions in for the enhancement of sport performance. Nevertheless, these practices
remain in need of more evidence-based support, to strengthen the field’s credibil-
ity and overcome a common negative stigma often associated with performance
consultation and therapy (Wicks, 2012). Even before this dimension of the field
is strengthened, the research (specifically on mindfulness training) must undergo
a shift toward more rigorous and structured methods of evaluation. Such changes
should not, conceivably, be impossible for an intervention of this nature. With the
field’s desperate need for increased evidence-based practice, mindfulness presents
a unique opportunity to develop one particular treatment approach through further
testing. Various forms of the intervention are well documented as effective clinical
therapy in other fields (e.g., Baer, 2003; Hofmann et al., 2010). Furthermore, the ease
with which mindfulness-based intervention programs can be delivered in a group
format is further incentive to enhance these research efforts, as time-consuming
face-to-face consultation with a client is not required beyond initial training.
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Appendix A: Outline of MAC Protocol
(See Gardner & Moore, 2007)
7 modules:
• Preparing the client with psychoeducation
• Introducing mindfulness and cognitive defusion
• Introducing values and values-driven behavior
• Introducing acceptance
• Enhancing commitment
• Skill consolidation and poise—combining mindfulness, acceptance, and com-
mitment
• Maintaining and enhancing mindfulness, acceptance, and commitment
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Appendix B: Checklist for Assessing
Methodological Quality
Study Score (0, 1)
Sufficient introduction/background provided to explain
rationale for study
Hypothesis/aim/objective is clearly described
Random selection was used
Random assignment was used

Participants were representative of the entire population
from which they were recruited
Outcome variables described
Participant eligibility criteria included
Participants’ demographic information included
Groups equal at baseline
Interventions adequately described
Dates of the study reported
Consistent time period between intervention and outcome
for control
and intervention groups
Adherence to study protocol
Sample sizes were adequate (at least 25 per group)
Sample sizes were adequate for subgroup analyses
At least 65% of selected sample completed the study
Description of retention for follow-up or explanation
provided for participants lost before follow-up
Intention-to-treat analysis followed
Appropriate statistical tests were used
Main results clearly described
Main outcome(s) was measured correctly
Means, SD/SE, CI, effect sizes reported
Actual probability values were reported
Study limitations described
Conclusions provided
Total Quality Score
262 JCSP Vol. 9, No. 3, 2015

Systematically Reviewing The Efficacy of Mindfulness-Based Interventions For Enhanced Athletic Performance

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Journal of Clinical Sport Psychology, 2015, 9, 232 -262

Systematically Reviewing the Efficacy

Keywords: mindfulness, applied sport psychology, systematic review

“The development and ultimate credibility of sport psychology will be

mismanagement are commonly linked to performance decrements and other

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credibility in clinical and health psychology contexts (Grossman, Niemann,

2007; Kaufman et al., 2009). Mindfulness training ultimately strives to instill a

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goal, as PST suggests (Moore, 2009). Instead, mindfulness-based performance

Mindfulness-Based Training Approaches

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up-to-date account of mindfulness interventions in sport. Given the noted gaps in

Literature Search Process

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resulting experience is characterized by high levels of engagement, absorption,

Assessment of Methodological Quality

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20–22: very good quality

Figure 1 — PRISMA diagram of search and screening process.

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• Referred by coach • Increase in flow, diving

“Sarah” • 13, an elite French • 11-month mindfulness- • Increase in objective

240 JCSP Vol. 9, No. 3, 2015

The effective application of mindfulness in a wide range of athletic contexts was a

life phenomenon, conclusions may be too narrow to be generalized to a wider

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them volunteered to participate in semistructured interviews designed to assess

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Table 2 Quality Assessment of Nonrandomized Trials

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Table 3 Research (Demographic) Characteristics of Nonrandomized Trials

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Table 5 Results/Findings from Nonrandomized Trials

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Limitations in Nonrandomized Open Trial Research

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Alternate/Distractor task employed for con-

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Moghadam et al. Iranian Premier League

Table 8 Interventions Employed in Randomized Trials

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Study Outcome(s) of Interest Results

• Significant differences in Cognitive-

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sufficient detail concerning the sample demographics, procedure and intervention,

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experimental (M = 151.00) and control groups (M = 131.57) on Global Flow in

Overview on Randomized Trials

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of the research thus far.

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using a mindfulness program. Anuario de Psicología/The UB. The Journal of Psychol-

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Stavrou, Thomas, Marsh, & Smethurst, 2007

Wicks, C.G. (2012). Adolescent equestrienne athletes’ experiences of mindfulness in