Mediators of acceptance and mindfulness-based therapies for anxiety and depression: A systematic review and meta-analysis.
M. Johannsen, E. Nissen, M. Lundorff, M. O'Toole
Clinical Psychology Review April 1, 2022 DOI: 10.1016/j.cpr.2022.102156 (opens in new tab) via Semantic Scholar
Summary
AI-generated from the abstractAcceptance and mindfulness-based therapies appear to work partly by increasing mindful attention, decentering, and acceptance, which in turn reduce anxiety and depression. A meta-analysis of 33 randomized controlled trials (30 independent trials) found that these three processes together had a small-to-medium mediating effect on treatment outcomes. However, the type of mediation analysis mattered: studies using correlation-based methods found significant mediating effects, while those using causal time-lag analyses did not. The specific role of each mediator could not be determined. Limitations in the number and design of available studies prevent firm conclusions about whether these processes are unique or causal.
Study at a glance
| Characteristics | Systematic review and meta-analysis of randomized controlled trials Peer reviewed |
|---|---|
| Sample size | 33 |
| Keywords | Medicine Psychology |
| Key finding | Mindful attention, decentering, and acceptance collectively showed a small-to-medium mediating effect on anxiety and depression outcomes in acceptance and mindfulness-based therapies, but mediator specificity could not be established and causal evidence was limited. |
Abstract
Acceptance and mindfulness-based therapies have shown efficacy in the treatment of anxiety and depression. Arguably, acceptance and mindfulness-based therapies target core processes in anxiety and depression by increasing mindful attention, decentering, and acceptance. The present study identified randomized controlled trials of acceptance and mindfulness-based therapies for anxiety and depression. Specifically, we aimed to synthesize the indirect effect of the three putative mediators (i.e., mindful attention, decentering, acceptance) on anxiety and depression. Electronic searches yielded 4989 unique records, which were screened for eligibility by two independent raters, resulting in the identification of 33 eligible studies (30 independent trials). The overall pooled mediating effect of mindful attention, decentering, and acceptance was small to medium (r = 0.145, p < .001). Type of mediation analysis emerged as the only statistically significant moderator. Specifically, studies using correlation-based mediation approaches showed statistically significant mediating effects, while studies using causal time-lag analyses did not yield statistically significant mediating effects. Mediator specificity could not be established. In conclusion, putative mediators of acceptance and mindfulness-based therapies mediated treatment effects on anxiety and depression. Limitations in study number, designs, and statistical approaches employed restrict conclusions regarding specificity and causality.