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A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders

Heidemarie Haller, Pascal Breilmann, Marleen Schröter, Gustav J Dobos, Holger Cramer

Scientific Reports October 14, 2021 DOI: 10.1038/s41598-021-99882-w (opens in new tab)

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Study at a glance

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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
Topics Anxiety Meditation
Key findings 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).

Comparable studies

Other systematic reviews and meta-analyses on anxiety, most cited first.

Study Year Design Participants
Meditation Programs for Psychological Stress and Well-being Diverse adult clinical populations 2014 Meta-analysis n = 3,515
Research Review: The effects of mindfulness‐based interventions on cognition and mental health in children and adolescents – a meta‐analysis of randomized controlled trials Children and adolescents 2018 Systematic review and meta-analysis n = 3,666
Therapeutic effects of classic serotonergic psychedelics: A systematic review of modern‐era clinical studies Patients with cancer- or illness-related anxiety and depression, major depressive... 2020 Systematic review n = 188
Does Mindfulness Meditation Improve Anxiety and Mood Symptoms? A Review of the Controlled Research Clinical populations with medical and emotional disorders 2007 Systematic review n = 15
Antidepressive, anxiolytic, and antiaddictive effects of ayahuasca, psilocybin and lysergic acid diethylamide (LSD): a systematic review of clinical trials published in the last 25 years Patients from included clinical trials 2016 Systematic review

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