Psychoneuroimmunology of Mindfulness: What works, how it works, and for whom?

As a major risk factor for mental and physical health disorders, chronic stress presents a critical public health challenge. Over the past decades, mindfulness-based interventions (MBIs) have gained empirical support as a promising approach to mitigating its harmful effects. However, important research gaps remain in the psychoneuroimmunology of mindfulness. This article synthesises the current state of research and identifies three central gaps that offer future directions for advancing the field. The first gap concerns the lack of a unified theoretical framework in mindfulness research, which hinders progress and cross-disciplinary integration. Researchers are invited to use the testable INterdiSciPlinary TheoretIcal FRamEwoRk (INSPIRER) that integrates the psychological, neural, and immune mechanisms by which mindfulness produces broad benefits across different levels of observation. The second gap refers to individual differences in responses to MBIs, emphasising the need for precision approaches to discover who benefits most and for whom these interventions may be contraindicated. Baseline levels of psychopathology are some of the participant characteristics that influence responses, but only further identification of participant characteristics and replication of existing ones will allow for more targeted interventions. The final gap addresses adaptations to existing MBIs that may further increase effectiveness or accessibility across diverse populations-such as varying intervention duration and doses of home practice or utilising technology. By addressing these three research gaps, we can advance the field of mindfulness in the 21st century 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.