Transdiagnostic effects of mindfulness-based interventions on emotion regulation and psychopathology in adolescents: A systematic review and meta-analysis.

Abstract

Emotion dysregulation (ED) is a core transdiagnostic process associated with diverse adolescent mental health problems. This systematic review and meta-analysis evaluated the transdiagnostic effects of mindfulness-based interventions (MBIs) on emotion regulation (ER) and key psychopathology domains in adolescents with ED or elevated emotional difficulties, and explored potential moderators. We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CNKI from inception to December 10, 2025. Individual and cluster randomized controlled trials involving adolescents aged 10-19 years were eligible if they reported at least one ER-related outcome. The primary outcome was ER-related measures (e.g., DERS, ERQ, rumination). Secondary outcomes were depressive symptoms, anxiety symptoms, and internalizing/overall distress. Random-effects models were used to pool standardized mean differences (Hedges' g). Prespecified subgroup analyses examined population type, control type, and setting. Exploratory meta-regressions tested mean age and in-class intervention dose. Publication bias and sensitivity analyses were conducted when appropriate. Eleven RCTs (INT/CON = 612/634) were included. Compared with controls, MBIs significantly improved ER (Hedges' g = -0.433, 95% CI -0.637 to -0.229; I2 = 62%). MBIs also reduced depressive symptoms (5 studies; SMD = -0.27, 95% CI -0.45 to -0.10; I2 = 0%), anxiety symptoms (4 studies; SMD = -0.57, 95% CI -0.78 to -0.36; I2 = 0%), and internalizing/overall distress (6 studies; SMD = -0.33, 95% CI -0.49 to -0.17; I2 = 19%). Control type significantly moderated ER effects (between-subgroup p = 0.04), with larger effects in the small subset of trials using active controls; however, this comparison was based on only three heterogeneous studies and should be interpreted cautiously. Higher in-class dose was associated with greater ER improvements (β = -0.144, p < 0.05), whereas mean age was not (p = 0.563). Egger's test suggested possible small-study effects (p = 0.037), but trim-and-fill imputed no missing studies and did not materially alter the pooled effect. MBIs show small-to-moderate benefits for emotion regulation and a broadly consistent beneficial pattern across depressive, anxiety, and internalizing/overall distress outcomes in adolescents with ED or elevated emotional difficulties. These findings support cautious consideration of ED-focused MBIs in clinical and school settings, while underscoring the need for larger, well-controlled trials to confirm dose-response relationships and clarify comparative efficacy against active controls.