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The Relationship Between Doses of Mindfulness-Based Programs and Depression, Anxiety, Stress, and Mindfulness: a Dose-Response Meta-Regression of Randomized Controlled Trials



Research with mindfulness-based programs (MBPs) has found participating in an MBP to predict beneficial outcomes; however, there is currently mixed research regarding the most helpful dose. This review aimed to determine whether different doses related to MBPs significantly predict outcomes.


Systematic literature searches of electronic databases and trial registration sites for all randomized controlled trials of MBPs identified 203 studies (N = 15,971). Depression was the primary outcome at post-program and follow-up, with secondary outcomes being mindfulness, anxiety and stress. Doses examined related to session numbers, duration and length, facilitator contact and practice. Dose-response relationships were analyzed using meta-regression in R with separate analyses for inactive and active controls.


Initial meta-analyses found significant between-group differences favoring MBPs for all outcomes. Meta-regression results suggested significant dose-response relationships for the mindfulness outcome for doses relating to face-to-face contact (d = 0.211; C.I.[0.064,0.358]), program intensity (d = 0.895; C.I.[0.315,1.474]) and actual program use (d = 0.013; C.I.[0.001,0.024]). The majority of results for psychological outcomes, including depression, were not significant.


This meta-regression examines dose-response relationships for different types and doses relating to MBPs. Considered together, MBPs appeared helpful compared with controls, supporting previous research. Based on meta-regression results, there was no evidence that larger doses are more helpful than smaller doses for predicting psychological outcomes; a finding consistent with some previous research particularly with non-clinical populations. Additionally, greater contact, intensity and actual use of MBPs predicting increased mindfulness correspond with previous research and theory. Potential limitations and recommendations for future research are explored.

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This work was carried out as part of a PhD in Psychology. The author would like to thank Fergal Jones (FJ), Clara Strauss (CS) and Kate Cavanagh (KC) for their supervision and consultation and for their scientific contributions. In particular, the author would like to thank Fergal Jones for his valuable help in the final preparation of the manuscript and Sabina Hulbert for statistical consultation. The author would also like to thank the authors of included studies who supplied the additional data and information needed for the meta-regression.

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PROSPERO International prospective register of systematic reviews registration number: CRD42017056864.

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Correspondence to Sarah Strohmaier.

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Strohmaier, S. The Relationship Between Doses of Mindfulness-Based Programs and Depression, Anxiety, Stress, and Mindfulness: a Dose-Response Meta-Regression of Randomized Controlled Trials. Mindfulness 11, 1315–1335 (2020).

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  • Mindfulness
  • Mindfulness-based programs
  • Dose-response
  • Meta-regression
  • Meta-analysis
  • RCT
  • Depression