The Effects of Mindfulness Techniques on Anxiety, Depression, and Stress, with an Emphasis on Gratitude: A Systematic Review and Meta-Analysis
Mădălina Sarca, Adriana Cojocaru, Raluca Dumache, Brenda Cristiana Bernad, Laura Alexandra Nussbaum, Iuliana Florina Costea, Teodora Anghel, Lavinia Hogea
Healthcare February 27, 2026 DOI: 10.3390/healthcare14050601 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review with meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 24,000 |
| Population | Participants from randomized controlled trials and quasi-experimental studies |
| Interventions | Mindfulness-Based Interventions gratitude-integrated MBIs |
| Duration | 8 to 12 weeks |
| Topics | Anxiety Meditation Depression |
| Keywords | Psychological intervention Mental health Randomized controlled trial Affect linguistics Meta-analysis Clinical psychology Psychotherapist Systematic review Depression economics Exposure therapy Medline Intervention counseling |
| Key findings | Mindfulness-Based Interventions produced a moderate improvement in psychological outcomes (Hedges' g = −0.45), with stronger effects for anxiety (g = −0.56) than depression (g = −0.45). |
Abstract
Background/Objectives: Mental health conditions such as anxiety, depression, and stress remain among the leading global causes of disability. Mindfulness-Based Interventions (MBIs) have gained increasing attention as effective non-pharmacological strategies for reducing psychological distress.
Methods: This systematic review examined 30 randomized controlled trials and quasi-experimental studies involving over 24,000 participants to evaluate the impact of MBIs on mental health outcomes, with a specific focus on the contribution of gratitude-based components.
Results: Studies varied in terms of population, duration, and format, with most demonstrating moderate to strong effects on symptom reduction, particularly in programs lasting 8 to 12 weeks. A random-effects meta-analysis was conducted, yielding a pooled effect size of Hedges’ g = −0.45, indicating a moderate improvement in psychological outcomes. Subgroup analyses revealed slightly stronger effects for anxiety (g = −0.56) than depression (g = −0.45). Gratitude-integrated MBIs demonstrated modestly enhanced emotional benefits, suggesting a synergistic role in improving well-being.
Conclusions: The review found low evidence of publication bias and acceptable risk of bias, supporting the moderate results. The findings underscore the value of MBIs, particularly those integrating gratitude, as scalable, cost-effective interventions in clinical and educational settings.
Comparable studies
Other systematic reviews and meta-analyses on anxiety, most cited first.
Citations in the library
Cites 23
- A mindfulness-based mobile health (mHealth) intervention among psychologically distressed university students in quarantine during the COVID-19 pandemic: A randomized controlled trial. Journal of Counseling Psychology July 15, 2021
- Mindfulness-based intervention for hypertension patients with depression and/or anxiety in the community: a randomized controlled trial. Trials May 2, 2024
- A randomized controlled trial of mindfulness: effects on university students' mental health. International journal of mental health systems October 13, 2023
- The effect of a mindfulness-based intervention on stress overload, depression, and mindfulness among nurses: A randomized controlled trial. Worldviews on Evidence-Based Nursing February 1, 2024
- Exploring the Effects of Variety and Amount of Mindfulness Practices on Depression, Anxiety, and Stress Symptoms: Longitudinal Study on a Mental Health-Focused eHealth System for Patients With Breast or Prostate Cancer. JMIR Mental Health November 21, 2024
and 18 more in the library