Protocol · graded by use, four uses
Purpose in life: meaning-centered therapy, purpose programs and volunteering
Self-reported meaning, purpose and distress, meaning-centered therapy (mostly people with cancer).
At a glance
This page is about feeling that your life has meaning and purpose. Many trials have tested talk-therapy programs that help people find meaning, mostly in people with cancer. These programs raised how much meaning and purpose people said they felt, and lowered sadness a little. These things are measured by asking people. The gains faded over time in the longest trial. Trials that gave older adults volunteer jobs found some gains in walking and fitness tests, but only in some groups. No trial has tested whether more purpose helps people live longer or avoid dementia.
- What was measured
- How much meaning and purpose in life people said they felt, with sadness and quality of life, on question scales.
- How big
- In one trial of people who had finished cancer treatment, purpose in life improved by an effect size How large a difference the treatment made, as distinct from whether the difference could be detected at all. of 0.69, a moderate change.Read from the summary of PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 28374663.
- Who it applies to
- Mostly adults with cancer, many with advanced cancer. Trials in older adults without serious illness were small.
- Safety
- The record lists no specific safety warning.
- Compared with
- Supportive group talks, usual care or a waiting list, depending on the trial.
- Certainty
- Grade B, resting on: Meta-analyses A study that pools the numbers from several trials into one combined estimate. of randomized trials and randomized trials (meaning, purpose, distress, physical and cognitive tests); population studies of purpose with death, dementia and heart disease are listed as excluded evidence and carry no letter.
- What would change this grade
- Could rise to A with: Randomized controlled trial People are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect. of a purpose-building program (for example structured volunteering) against usual life. Who: Adults aged 60 and over without dementia, several thousand per arm. Measured: Death, dementia and disability, with purpose in life measured along the way. Length: At least 5 years.
- Cost
- No price recorded yet.
- Sources
- 33 studies cited on this record, listed under Sources.
The B belongs to one of the four uses graded on this record. The other three carry their own letters.
This record carries a separate letter for each thing it has been measured on. The headline grade is the best of them, and it does not transfer to the others.
Breitbart et al. (2015; PMID 25646186): 253 patients with advanced cancer, benefit for quality of life, depression and hopelessness on intent to treat. Breitbart et al. (2018; PMID 29757459): 321 patients, small to medium effects against usual care (d 0.1 to 0.34). van der Spek et al. (2017; PMID 28374663): 170 survivors, personal meaning d = 0.81, purpose in life d = 0.69. Kissane et al. (2023; PMID 38051407): meaning subscale d = 0.4. Park et al. (2019; PMID 31034600): 29 trials, g = 0.37. Shen et al. (2025; PMID 39747698): sense of meaning SMD 0.22, depressive symptoms SMD -0.15. Self-reported, replicated The same finding reproduced by a separate research group. A result seen once can be chance or bias; a replicated one is harder to explain away. by independent groups: B. Limits: gains faded by 2 years (Holtmaat 2020, PMID 31876012); the Meaning-Making intervention found no effect (Henry 2026, PMID 41856946); pooled psychological and spiritual interventions showed no effect on meaning (Martinez-Calderon 2023, PMID 37584817); no significant effect on spiritual well-being, depression or anxiety in 5 trials pooled by Kim 2024 (PMID 39234685).
Westerhof et al. (2010; PMID 20045873): life review raised personal meaning against a video control in 171 older adults, no longer significant at 6 months. Chippendale et al. (2015; PMID 26114464): life review writing plus an intergenerational exchange raised purpose and meaning more than writing alone. Jongenelis et al. (2022; PMID 33571004): in an Australian volunteering trial, only a per-protocol comparison (73 who volunteered against 112 controls who did not) showed gains in purpose in life over 12 months. Jiang et al. (2021; PMID 31986905): 384 adults aged 50 to 96, a volunteering program did not change meaning in life. Small trials, mixed results, the positive volunteering result per protocol only: C.
Varma et al. (2016; PMID 26340864): in the Baltimore Experience Corps trial, women volunteering in public schools for 2 years walked 1,500.3 more steps a day than controls, men did not. Pettigrew et al. (2020; PMID 31201669): 445 Australians aged 60 and over; volunteering improved sit-to-stand scores in both analyses and fast-pace walk in the pragmatic analysis only. Fried et al. (2004; PMID 15047786): pilot of 128 volunteers, physical activity and strength rose and walking speed fell less than in controls. Thinking tests: Brydges et al. (2021; PMID 31950167), 336 participants, intent-to-treat analyses found no significant improvement on standard measures; Carlson et al. (2008; PMID 19139252), pilot of 149, gains only in those with impaired executive function at baseline. Carlson et al. (2015; PMID 25835516): brain volume gains significant in men only (an imaging measure, not a clinical outcome). Gruenewald et al. (2016; PMID 25721053) found higher self-rated generativity, and Yeung et al., HEAL-HOA (2025; PMID 39855242), lower self-reported loneliness at 6 months, mostly not sustained at 12 months. The trial's planned primary outcome, disability (PMID 23680986), has not been reported in PubMed. Subgroup-only and mixed results: C.
No randomized trial has tested whether building purpose or meaning lowers death, dementia or heart disease. The associations come from cohorts: purpose and mortality and cardiovascular events (Cohen 2016, PMID 26630073), purpose and mortality and Alzheimer disease in the Rush cohorts (Boyle 2009, PMID 19414613; Boyle 2010, PMID 20194831), purpose and dementia (Sutin 2021, PMID 34275900), and volunteering and mortality (Okun 2013, PMID 23421326). These are listed as excluded evidence and carry no letter. D here means the trial has not been run, not that one failed.
Raising self-reported meaning and purpose, and lowering depression and distress, with structured meaning programs, mostly meaning-centered psychotherapy in people with cancer (B). Meaning and purpose programs for older adults without serious illness rest on small or mixed trials (C). Volunteering programs for older adults on physical activity, physical tests and thinking tests: mixed trials (C). Death, dementia and heart disease: no randomized trial (D).
Why this letter
Why this gradeThe reasoning, and what the grade does not cover.
Grade B on self-reported meaning and purpose. Independent research groups in the United States (Breitbart 2015, PMID 25646186; Breitbart 2018, PMID 29757459), the Netherlands (van der Spek 2017, PMID 28374663), Australia (Kissane 2023, PMID 38051407), China (Wang 2023, PMID 37558651) and Spain (Marco 2024, PMID 39174266) found meaning-centered therapy raised meaning and purpose, and two meta-analyses of randomized trials agree (Park 2019, PMID 31034600, g = 0.37; Shen 2025, PMID 39747698, moderate-quality evidence).
WHY NOT Ameaning, purpose, depression and distress are reported by the person, and self-report caps a record at B however many trials agree. The effects are small to moderate, they faded by 2 years in the longest follow-up (Holtmaat 2020, PMID 31876012), and not every trial agrees: the Meaning-Making intervention found no effect (Henry 2026, PMID 41856946) and a pooled analysis of 8 trials of psychological and spiritual interventions found none on meaning (Martinez-Calderon 2023, PMID 37584817).
WHAT THIS GRADE DOES NOT COVERmost trials enrolled people with cancer, so the B does not transfer to healthy adults, where the trials are few and small (graded C); volunteering, graded separately at C; and living longer, dementia and heart disease, where no randomized trial has been run and the evidence is population studies (Cohen 2016, PMID 26630073; Boyle 2009, PMID 19414613; Boyle 2010, PMID 20194831; Sutin 2021, PMID 34275900).
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Trials report an average. This box says whether any trial on this record looked at who the result applies to, and what it found.
For this record's Grade B · Subgroup tested, effect differedPark et al. (Cancer, 2019; PMID 31034600) found larger effects for interventions designed to enhance meaning (g = 0.42) than for those aimed at other outcomes (g = 0.18). In the Baltimore Experience Corps trial, walking rose in women and not men (Varma et al., American Journal of Preventive Medicine, 2016; PMID 26340864), while brain volume gains reached significance in men only (Carlson et al., Alzheimer's and Dementia, 2015; PMID 25835516). A subgroup result shows who the effect appeared in within these trials. It does not change the letter.
Evidence notes: meta-analysis of randomized trials, randomized trial
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: Self-reported meaning in life and purpose on validated questionnaires (for example the meaning subscale of the FACIT-Sp, the Personal Meaning Profile, Ryff's purpose in life scale), with self-reported depression and distress (self_report)
Last reviewed: October 2026
The trial that would change this grade.
Positive trials of this shape from independent research groups would move this entry to A.
Why the current trials fall short
The trials show self-reported meaning and purpose rise. The Baltimore Experience Corps trial was designed to measure disability, and its primary result has not appeared in PubMed; a trial reporting death, dementia or disability could settle whether purpose programs change health.
ClinicalTrials.gov, the public registry run by the U.S. National Library of Medicine, lists studies that are recruiting volunteers. The link below searches it for Meaning-Centered among studies recruiting now. EBL has no relationship with any listed study and receives no payment for this link.
Search recruiting studies of Meaning-Centered on ClinicalTrials.gov
Dose, form and timing
Measured outcome: meaning and purpose scored on a validated questionnaire before and after the program, usually with depression, anxiety and quality of life questionnaires. The volunteering trials also measured steps a day by device (PMID 26340864), chair sit-to-stand and walking tests (PMID 31201669), cognitive tests (PMID 31950167; PMID 19139252) and brain volume on MRI (PMID 25835516).
As studiedDose, form, population and duration for every use.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
Safety
No safety data. Each caution on this record, sorted by what it rests on.
None recorded.
None recorded.
None recorded.
None recorded.
No safety data: EBL has found no trial or report of harm for this record. That is an absence of evidence, not a finding of safety.
Grade history
How this letter has changedLatest: No. 387 · October 2026 · First graded.
Purpose in life: meaning-centered therapy, purpose programs and volunteering now has its own record, graded use by use after a full PubMed search in October 2026: Self-reported meaning, purpose and distress, meaning-centered therapy (mostly people with cancer) (B); Self-reported meaning and purpose, programs for older adults without serious illness (C); Physical activity, physical tests and thinking tests, structured volunteering for older adults (C); Death, dementia and heart disease (D). Raising self-reported meaning and purpose, and lowering depression and distress, with structured meaning programs, mostly meaning-centered psychotherapy in people with cancer (B). Meaning and purpose programs for older adults without serious illness rest on small or mixed trials (C). Volunteering programs for older adults on physical activity, physical tests and thinking tests: mixed trials (C). Death, dementia and heart disease: no randomized trial (D). Applied the written grade definitions under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 25646186 PMID 29757459 PMID 19274623 PMID 22370330 PMID 28374663 PMID 31876012 PMID 38051407 PMID 37558651 PMID 39174266 PMID 31034600 PMID 39747698 PMID 33626890
Every change to a letter on this site is dated and published. The full evidence log →
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- October 2026. By a language model (AI-assisted reading), not yet reviewed by a clinician.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
The evidence, in full33 papers, each linked to its PubMed record.
Breitbart et al. (Journal of Clinical Oncology, 2015; PMID 25646186): 253 patients with advanced cancer randomized to 8 sessions of meaning-centered group psychotherapy or supportive group psychotherapy; in intent-to-treat analyses, greater benefit for quality of life, depression and hopelessness. Breitbart et al. (Cancer, 2018; PMID 29757459): 321 patients with advanced cancer randomized to individual meaning-centered psychotherapy, supportive psychotherapy or enhanced usual care; against usual care, meaning-centered therapy improved 5 of 7 outcomes including sense of meaning, with Cohen's d from 0.1 to 0.34, and against supportive therapy it improved quality of life and sense of meaning (d = 0.19). Breitbart et al. (Psycho-Oncology, 2010; PMID 19274623) and Breitbart et al. (Journal of Clinical Oncology, 2012; PMID 22370330) were the pilot trials (90 and 120 patients); in the 2012 trial the gains were no longer significant at 2 months. van der Spek et al. (Psychological Medicine, 2017; PMID 28374663): 170 cancer survivors in the Netherlands; against care as usual, personal meaning d = 0.81 and purpose in life d = 0.69 after the program, depression d = -0.38 at 6 months. Holtmaat et al. (Psycho-Oncology, 2020; PMID 31876012): at 2-year follow-up of that trial the short-term gains in personal meaning had faded. Kissane et al. (Supportive Care in Cancer, 2023; PMID 38051407): 107 patients with advanced cancer in Australia; Meaning and Purpose therapy raised posttraumatic growth (d = 0.7) and the meaning subscale of spiritual well-being (d = 0.4). Wang et al. (Palliative and Supportive Care, 2023; PMID 37558651): 66 Chinese patients with cancer; meaning in life improved, psychological distress did not. Marco et al. (Behavior Therapy, 2024; PMID 39174266): 76 cancer survivors in Spain; meaning-centered therapy raised meaning and purpose more than cognitive behavioral therapy and was equally effective for depression. Meta-analyses: Park et al. (Cancer, 2019; PMID 31034600), 29 randomized trials, 2,305 patients with cancer, meaning and purpose g = 0.37 (95% CI 0.22 to 0.52), g = 0.42 for interventions designed to enhance meaning; Shen et al. (Supportive Care in Cancer, 2025; PMID 39747698), 12 studies, 1,459 patients with advanced cancer, sense of meaning SMD 0.22 (95% CI 0.09 to 0.36) and depressive symptoms SMD -0.15 (95% CI -0.24 to -0.05), quality of life benefit not sustained at 2 to 6 months; Manco et al. (American Journal of Health Promotion, 2021; PMID 33626890), 33 randomized trials across populations, meaning in life SMD 0.85 (95% CI 0.54 to 1.17) against passive controls and a smaller effect against active controls (95% CI 0.09 to 0.55); Vos et al. (Journal of Consulting and Clinical Psychology, 2015; PMID 25045907), meaning therapies d = 0.65 on meaning in life, no significant effect on self-reported physical well-being in the one study that measured it. Null results: Henry et al. (Psycho-Oncology, 2026; PMID 41856946), 239 patients newly diagnosed with advanced cancer, the Meaning-Making intervention did not change meaning in life at 2, 4 or 6 months; Martinez-Calderon et al. (Supportive Care in Cancer, 2023; PMID 37584817), 8 randomized trials (1,682 patients) of psychological and spiritual interventions, no effect on meaning (MD -0.19, 95% CI -0.45 to 0.06), certainty low; Kim et al. (Clinical Nursing Research, 2024; PMID 39234685), 5 trials in 718 patients with advanced cancer, no significant effect on spiritual well-being, depression or anxiety. Older adults without serious illness: Westerhof et al. (The Gerontologist, 2010; PMID 20045873), life review in 171 older adults raised personal meaning against a video control, no longer significant at 6-month follow-up; Chippendale et al. (American Journal of Occupational Therapy, 2015; PMID 26114464), life review writing plus an intergenerational exchange raised purpose and meaning in life more than writing alone. Volunteering: Varma et al. (American Journal of Preventive Medicine, 2016; PMID 26340864), Baltimore Experience Corps, 123 adults aged 60 and over, women placed as school volunteers walked 1,500.3 more steps a day than controls at 24 months (95% CI 77.6 to 2,922.9), men did not; Pettigrew et al. (Aging Clinical and Experimental Research, 2020; PMID 31201669), 445 Australians aged 60 and over, volunteering at least 1 hour a week improved sit-to-stand scores; Brydges et al. (Journals of Gerontology Series B, 2021; PMID 31950167), 336 Experience Corps participants, intent-to-treat analyses showed no significant improvement on standard cognitive measures; Carlson et al. (Alzheimer's and Dementia, 2015; PMID 25835516), brain volumes rose in men in the volunteer arm (0.7% to 1.6%); Jiang et al. (Aging and Mental Health, 2021; PMID 31986905), 384 adults aged 50 to 96 in Hong Kong, a volunteering program did not change meaning in life, depressive symptoms, self-efficacy or autonomy. Yeung et al., HEAL-HOA (Lancet Healthy Longevity, 2025; PMID 39855242): in a volunteering program for older adults, self-reported loneliness was reduced at 6 months, mostly not sustained at 12 months.
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
("meaning-centered"[tiab] OR "meaning centered"[tiab] OR logotherap*[tiab] OR "meaning in life"[tiab] OR "purpose in life"[tiab] OR "sense of purpose"[tiab]) AND (intervention*[tiab] OR therap*[tiab] OR program*[tiab]) AND (randomized controlled trial[pt] OR meta-analysis[pt])PubMed watch: does a new study change the grade? (nothing new)
No new paper matching the search behind this grade has been added to PubMed since October 2026.
Last run October 2026. A letter on EBL moves only after a logged review. A new paper never moves a letter by arriving: it is read, the answer is written here, and any change to the letter is published in the evidence log.
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