A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders
H. Haller, Pascal Breilmann, Marleen Schröter, G. Dobos, H. Cramer
Scientific Reports October 14, 2021 DOI: 10.1038/s41598-021-99882-w (opens in new tab) via Semantic Scholar
Summary
AI-generated from the abstractA meta-analysis of 23 randomized controlled trials with 1,815 adults diagnosed with DSM-5 anxiety disorders found that Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy, and Mindfulness-Based Stress Reduction produce short-term reductions in anxiety when added to treatment as usual, compared to treatment as usual alone. Compared to Cognitive Behavioral Therapy, ACT and MBCT showed comparable effects on anxiety, while MBSR showed significantly lower effects. Effects at 6- and 12-month follow-ups were not significantly different from treatment as usual or CBT. Effects on depression and quality of life followed similar trends. Whether these interventions have specific effects beyond placebo remains unclear.
Study at a glance
| Characteristics | Meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 1,815 |
| Population | Adults with DSM-5 anxiety disorders |
| Interventions | Acceptance and Commitment Therapy Mindfulness-Based Cognitive Therapy Mindfulness-Based Stress Reduction |
| Keywords | Medicine Psychology |
| Key finding | Acceptance- and mindfulness-based interventions produce short-term anxiolytic effects when added to treatment as usual, but specific treatment effects beyond placebo remain unclear. |
Abstract
This meta-analysis systematically reviewed the evidence on standardized acceptance-/mindfulness-based interventions in DSM-5 anxiety disorders. Randomized controlled trials examining Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), and Mindfulness-Based Stress Reduction (MBSR) were searched via PubMed, Central, PsycInfo, and Scopus until June 2021. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for primary outcomes (anxiety) and secondary ones (depression and quality of life). Risk of bias was assessed using the Cochrane tool. We found 23 studies, mostly of unclear risk of bias, including 1815 adults with different DSM-5 anxiety disorders. ACT, MBCT and MBSR led to short-term effects on clinician- and patient-rated anxiety in addition to treatment as usual (TAU) versus TAU alone. In comparison to Cognitive Behavioral Therapy (CBT), ACT and MBCT showed comparable effects on both anxiety outcomes, while MBSR showed significantly lower effects. Analyses up to 6 and 12 months did not reveal significant differences compared to TAU or CBT. Effects on depression and quality of life showed similar trends. Statistical heterogeneity was moderate to considerable. Adverse events were reported insufficiently. The evidence suggests short-term anxiolytic effects of acceptance- and mindfulness-based interventions. Specific treatment effects exceeding those of placebo mechanisms remain unclear. Protocol registry: Registered at Prospero on November 3rd, 2017 (CRD42017076810).