Psychoneuroimmunology of mindfulness: What works, how does it work, and for whom does it work best?

The consequences of chronic stress present a major public health challenge, and we are beginning to understand ways to mitigate these damaging effects. Research on mindfulness has accumulated over the past decades and suggests that it can counteract the psychological, neural, and immune effects of chronic stress, but more research is required to provide precise clinical guidelines. This article describes mindfulness interventions in a language that can be understood by researchers from different backgrounds, reviews three central gaps, and provides future directions for research on the psychoneuroimmunology of mindfulness. The first gap addresses the need to explore adaptations to existing mindfulness interventions that may further increase effectiveness or accessibility across diverse populations—such as varying intervention duration and doses of home practice or utilising technology. The second gap refers to a lack of consensus on the theoretical framework in mindfulness research that blocks progress. Researchers are invited to use the Interdisciplinary Theoretical Framework (INSPIRER) that integrates disciplines and explains the psychological, neural, and immune mechanisms by which mindfulness produces broad benefits across different levels of observation. The final gap refers to individual differences in responses to mindfulness interventions, and discovering who benefits the most from mindfulness interventions. Baseline levels of psychopathology are some of the participant characteristics that influence responses to mindfulness interventions, but only further identification of participant characteristics and replication of existing ones will allow for more targeted approaches. By addressing these three research gaps in the 21st century, we can advance the field of mindfulness and contribute to the development of cost-effective and personalised interventions that can be applied on a large scale to mitigate the effects of chronic stress and protect human health.