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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.

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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