Anxiety and Stress-Related Disorders and Mindfulness-Based Interventions: a Systematic Review and Multilevel Meta-analysis and Meta-Regression of Multiple Outcomes

Abstract

Mindfulness-based interventions (MBIs) have emerged as alternative treatments to treat anxiety and stress-related disorders. The aim of this study is to investigate the effectiveness of MBIs if compared to control interventions and cognitive behavioral therapy (CBT) to improve internalizing symptoms in patients with anxiety and stress-related disorders. We performed a systematic review and multilevel meta-analysis of randomized controlled trials. Outcomes were anxiety, stress, and depression rating scales (internalizing symptoms), further classified as pertaining to distress and fear symptom domains. A total of 40 outcomes were retrieved from 10 studies. MBIs were superior to control interventions for internalizing and distress, but not for fear symptoms. CBT was not superior to MBIs for internalizing and distress, but CBT was superior to MBIs for fear symptoms. The majority of the included studies have a high risk of bias and small sample size, and we found evidence of publication bias for some outcomes. Therefore, results should be interpreted cautiously. MBIs seem promising therapeutic options for treating distress symptoms in anxiety disorders; however, more research is needed to recommend MBIs as first-line treatments. MBIs do not seem effective to treat fear symptoms, for which CBT is significantly more effective.

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Contributors

Author Marianna de Abreu Costa designed the study and wrote the study protocol, managed the literature searches, extracted the data, performed the analyses, and wrote the first draft of the manuscript.

Author Gabriela Santos D’Alò de Oliveira helped to design the study, managed the literature searches, extracted the data, revised the manuscript, and contributed to the final version of the manuscript.

Author Tiago Tatton-Ramos participated in the study design, revised the manuscript, and contributed to the final version of the manuscript.

Author Gisele Gus Manfro participated in the study design, revised the manuscript, and contributed to the final version of the manuscript.

Author Giovanni Abrahão Salum participated in the study design, contributed to the study protocol, supervised the data analyses, revised the manuscript, and contributed to the final version of the manuscript.

All authors have approved the final version of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Researches’ scholarships and funding for the research group were funded by Brazilian government agencies (CNPq and FIPE-HCPA).

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Correspondence to Marianna de Abreu Costa.

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MAC, GS, GGM, and GAS declare no conflicts of interest. TT is a cofounder of Iniciativa Mindfulness in Brazil.

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de Abreu Costa, M., D’Alò de Oliveira, G.S., Tatton-Ramos, T. et al. Anxiety and Stress-Related Disorders and Mindfulness-Based Interventions: a Systematic Review and Multilevel Meta-analysis and Meta-Regression of Multiple Outcomes. Mindfulness 10, 996–1005 (2019). https://doi.org/10.1007/s12671-018-1058-1

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Keywords

  • Behavior therapy
  • Psychotherapy
  • Mindfulness, anxiety disorders
  • Affective symptom
  • Internalizing symptoms