Mindfulness-based stress reduction interventions and cortisol regulation: A systematic review and meta-analysis.
Blair T Johnson, Taryn J Simon, Chen Li, Emersyn K Rokos, Lisset Martinez-Berman, Matthew B Jané, Sarah S Tsai, Eric B Loucks
Health Psychology September 3, 2026 DOI: 10.1037/hea0001636 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review and meta-analysis Randomized Peer reviewed |
|---|---|
| Sample size | 2,059 |
| Population | Participants in MBSR intervention studies |
| Intervention | Mindfulness-based stress reduction (MBSR) |
| Topics | Meditation |
| Key findings | MBSR significantly reduced cortisol levels in within-group analyses, especially in randomized controlled trials (g = -0.37), but not in uncontrolled studies. Between-group analyses showed MBSR was more effective than control conditions (g = -0.38), with larger effects versus inactive controls (g = -0.42) and smaller effects versus active controls (g = -0.29). |
Abstract
Chronic stress is a growing public health concern, with cortisol widely recognized as its primary physiological biomarker. Mindfulness-based stress reduction (MBSR), a standardized multiweek program, has shown promise in improving psychological outcomes, yet its specific effects on cortisol levels have not been meta-analyzed. We conducted a systematic review and meta-analysis of eligible MBSR trials, those that (a) reported pre- and postintervention cortisol levels and (b) controlled for timing of cortisol collection. Thirty-nine MBSR intervention studies met the inclusion criteria, with 2,059 participants. Within-group analyses revealed a statistically significant reduction in cortisol levels following MBSR (k = 53, g = -0.26, 95% confidence interval [-0.38, -0.14], particularly in randomized controlled trials (k = 26, g = -0.37 [-0.53, -0.20]), but not in uncontrolled studies (k = 18, g = -0.06 [-0.19, 0.07]). Between-group analyses showed MBSR to be significantly more effective than control conditions in lowering cortisol (k = 34, g = -0.38 [-0.56, -0.21). MBSR had larger reductions compared with inactive controls (k = 23, g = -0.42 [-0.63, -0.20]) and smaller reductions compared with active controls (k = 11, g = -0.29 [-0.54, -0.04]). Significant heterogeneity remained unexplained. MBSR interventions reduce cortisol, although results vary across studies. As MBSR provides a physiological benefit, it deserves greater implementation in stress reduction initiatives. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Comparable studies
Other systematic reviews and meta-analyses on meditation, 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 |
| Mindfulness-Based Stress Reduction for Stress Management in Healthy People: A Review and Meta-Analysis Healthy subjects | 2009 | Systematic review and meta-analysis | |
| The psychological effects of meditation: A meta-analysis. Nonclinical groups of adult meditators | 2012 | Meta-analysis | n = 163 |
| Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse Adults with recurrent depression in full or partial remission | 2016 | Meta-analysis of individual patient data from randomized controlled trials | n = 1,258 |
| Mindfulness‐Based Stress Reduction and Mindfulness‐Based Cognitive Therapy – a systematic review of randomized controlled trials | 2011 | Systematic review |