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The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials
Open accessAbstract
In response to questions regarding the scientific basis for mindfulness-based interventions (MBIs), we evaluated their empirical status by systematically reviewing meta-analyses of randomized controlled trials (RCTs). We searched six databases for effect sizes based on four or more trials that did not combine passive and active controls. Heterogeneity, moderators, tests of publication bias, risk of bias, and adverse effects were also extracted. Representative effect sizes based on the largest number of studies were identified across a wide range of populations, problems, interventions, comparisons, and outcomes (PICOS). A total of 160 effect sizes were reported in 44 meta-analyses ( k = 336 RCTs, N = 30,483 participants). MBIs showed superiority to passive controls across most PICOS ( ds = 0.10–0.89). Effects were typically smaller and less often statistically significant compared with active controls. MBIs were similar or superior to specific active controls and evidence-based treatments. Heterogeneity was typically moderate. Few consistent moderators were found. Results were generally robust to publication bias, although other important sources of bias were identified. Reporting of adverse effects was inconsistent. Statistical power may be lacking in meta-analyses, particularly for comparisons with active controls. Because MBIs show promise across some PICOS, future RCTs and meta-analyses should build on identified strengths and limitations of this literature.
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“Much of the ST literature relies on self-report instruments such as the Self-Transcendence Scale (109) and the Nondual Awareness Dimensional Assessment (38), which—like other contemplative measures—face issues of construct overlap and response bias (110).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [110]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Mindfulness meditation (MM) is one individual‐level solution that has shown promise for reducing burnout in clinicians, but has not been studied in GCs.”
From The effects of mindfulness meditation on burnout in clinical genetic counselors: A three-arm randomized controlled trial (2026) · cites this paper as Goldberg et al., 2022
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Meditation trials with passive controls can overestimate effect sizes by 30%–40% compared to those with active controls (Goldberg et al., 2022; Goyal et al., 2014).”
From The effects of mindfulness meditation on burnout in clinical genetic counselors: A three-arm randomized controlled trial (2026) · cites this paper as Goldberg et al., 2022
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A 2022 systematic review found mindfulness superior to active controls for stress in healthcare providers (Cascales‐Pérez et al., 2021; Goldberg et al., 2022).”
From The effects of mindfulness meditation on burnout in clinical genetic counselors: A three-arm randomized controlled trial (2026) · cites this paper as Goldberg et al., 2022
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“These findings need to be interpreted with caution, given that they arise from secondary analyses, and because it has been well demonstrated that comparisons to a passive control can both overestimate effect sizes and identify effectiveness erroneously (Davidson & Kaszniak, 2015; Goldberg et al., 2022; Kinser & Robins, 2013).”
From The effects of mindfulness meditation on burnout in clinical genetic counselors: A three-arm randomized controlled trial (2026) · cites this paper as Goldberg et al., 2022
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“Meta-analyses involving hundreds of randomized controlled trials (RCTs) suggest that meditation training can decrease psychological symptoms (eg, depression, anxiety, stress) and increase aspects of well-being and positive functioning (eg, meaning in life, compassion, prosocial behavior) [6-15].”
From Testing the efficacy of a multicomponent, self-guided, smartphone-based meditation app: Three-armed randomized controlled trial (2020) · cites this paper as [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“MBIs have demonstrated efficacy in addressing comorbid conditions, such as depressive symptoms and stress, which are frequently associated with SUD [24, 25].”
From The feasibility of mindfulness‐based relapse prevention for adults with substance use disorders (illicit drugs) in a Chinese population: A pilot randomized controlled trial. (2026) · cites this paper as [24]
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“This is consistent with previous literature whereby mindfulness-based interventions were slightly superior to other active controls in adults when analysing a variety of health outcomes, including stress (Goldberg et al., 2022).”
From Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis. (2024) · cites this paper as Goldberg et al., 2022
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In the citing paper
“and larger magnitude of effects specific to mindfulness interventions were when compared to passive controls, with smaller, yet still significant effects when compared to some active controls (Goldberg et al., 2022).”
From Effectiveness of stress management interventions to change cortisol levels: a systematic review and meta-analysis. (2024) · cites this paper as Goldberg et al., 2022
In the citing paper
“there is overwhelming evidence that mindfulness-based interventions (MBIs) might be helpful for psychological and to a lesser extent physical health in clinical5,6 and non-clinical populations7,8.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [5]
In the citing paper
“MBIs might reduce psychosomatic outcomes like pain and sleep relative to no treatment, although evidence is less robust particularly for sleep than that for psychological symptoms, with fewer studies available and confidence intervals that include zero5.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [5]
In the citing paper
“There is some evidence that MBIs slightly outperform specific active controls (other interventions intended to be therapeutic, such as physical exercise or relaxation training54) on psychiatric symptoms6 but not physical health conditions5.”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [5]
In the citing paper
“Differences between MBIs and other therapies are small when compared directly in RCTs (standardized mean difference ≈ ≤ 0.20, limited relative efficacy5).”
From A common factors perspective on mindfulness-based interventions (2022) · cites this paper as [5]
In the citing paper
“If control conditions are interpreted as a homogeneous group, interventions compared with stronger control conditions may be perceived as less effective18,26.”
From Selecting and describing control conditions in mobile health randomized controlled trials: a proposed typology (2023) · cites this paper as [26]
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Citations
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“The prototypical MBI, mindfulness-based stress reduction (MBSR; Kabat-Zinn, 2013), has been widely studied and, to some extent, disseminated in clinical and nonclinical populations (Bohlmeijer et al., 2010; Chiesa & Serretti, 2009).”
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“This magnitude of heterogeneity is similar to estimates found in large-scale meta-analyses of evidence-based psychotherapies (e.g., cognitive behavioral therapy, interpersonal psychotherapy; Cuijpers et al., 2011, 2013).”
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“Moreover, meta-analyses of this literature have at times come to contrasting conclusions even when evaluating theoretically similar constructs and presumably somewhat overlapping primary studies (e.g., prosocial effects of meditation; Donald et al., 2019; Kreplin et al., 2018).”
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“With few exceptions (e.g., comparison conditions that involve sham or dismantled meditation; Lindsay et al., 2019; Zeidan et al., 2010), it is typically not possible to blind participants and mindfulness instructors to the condition they are receiving or providing.”
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“With few exceptions (e.g., comparison conditions that involve sham or dismantled meditation; Lindsay et al., 2019; Zeidan et al., 2010), it is typically not possible to blind participants and mindfulness instructors to the condition they are receiving or providing.”
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“For MBIs with established efficacy (e.g., MBCT for prevention depression relapse), dissemination and implementation RCTs may be appropriate (Dimidjian & Segal, 2015).”
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“Having a publicly available database of MBI RCTs with associated effect sizes (as has been done for psychotherapies for depression; Cuijpers et al., 2020) could facilitate future large-scale, open science meta-analyses of this literature.”
BackgroundEich, E. (2014) · Psychology Science · doi:10.1177/0956797613512465 · Cited by 267 · cited 1×
“Strategies adopted to incentivize open science (e.g., badges for preregistration, methodology disclosure statements; Eich, 2014) are promising models.”
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The role of method in treatment effectiveness research: Evidence from meta-analysis.
Wilson, D. B., & Lipsey, M. W. (2001) · Psychological Methods · doi:10.1037/1082-989x.6.4.413 · Cited by 261 · cited 1×
“Although some previous reviews have conducted a second-order meta-analysis by quantitatively combining results across included meta-analyses (e.g., Wilson & Lipsey, 2001), this approach has the substantial limitation of overrepresenting studies published earlier (that may be more likely to appear…”
MethodResearcher allegiance in psychotherapy outcome research: An overview of reviews
Munder, T., Brütsch, O., Leonhart, R., Gerger, H., & Barth, J. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.02.002 · Cited by 260 · cited 1×
“However, even for these comparisons, it is crucial that researcher allegiance to MBIs be balanced with allegiance to the comparison condition (Goldberg & Tucker, 2020; Munder et al., 2013).”
BackgroundStratton, E., Lampit, A., Choi, I., Calvo, R. A., Harvey, S. B., & Glozier, N. (2017) · PLOS ONE · doi:10.1371/journal.pone.0189904 · Cited by 252
The limited prosocial effects of meditation: A systematic review and meta-analysis
Kreplin, U., Farias, M., & Brazil, I. A. (2018) · Scientific Reports · doi:10.1038/s41598-018-20299-z · Cited by 211 · cited 1×
“Moreover, meta-analyses of this literature have at times come to contrasting conclusions even when evaluating theoretically similar constructs and presumably somewhat overlapping primary studies (e.g., prosocial effects of meditation; Donald et al., 2019; Kreplin et al., 2018).”
ResultLeyland, A., Rowse, G., & Emerson, L.-M. (2019) · Emotion · doi:10.1037/emo0000425 · Cited by 206 · cited 1×
“(2019) that characterize MBIs as training that includes the cultivation of a present-moment focus through the engagement in sustained meditation practice (i.e., not a single mindfulness induction; Leyland et al., 2018).”
BackgroundDoes mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis
Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015) · British Journal of General Practice · doi:10.3399/bjgp15x685297 · Cited by 197
Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis
Anheyer, D., Haller, H., Barth, J., Lauche, R., Dobos, G., & Cramer, H. (2017) · Annals of Internal Medicine · doi:10.7326/m16-1997 · Cited by 197
Cooper, H., & Koenka, A. C. (2012) · American Psychologist · doi:10.1037/a0027119 · Cited by 196 · cited 1×
“As noted by Cooper and Koenka (2012), no definitive, established method for this task exists.”
BackgroundBeronio, K. K., Glied, S., & Frank, R. G. (2014) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-014-9412-0 · Cited by 188 · cited 1×
“, 2008), cognitive behavioral therapy and other psychotherapies are widely perceived as efficacious by the research community and general public, recommended by providers, and paid for by managed care organizations (Beronio et al., 2014; Seligman, 1995; Wampold & Imel, 2015).”
BackgroundJonsson, U., Alaie, I., Parling, T., & Arnberg, F. K. (2014) · Contemporary Clinical Trials · doi:10.1016/j.cct.2014.02.005 · Cited by 175
Khoo, E.-L., Small, R., Cheng, W., Hatchard, T., Glynn, B., Rice, D. B., Skidmore, B., Kenny, S., Hutton, B., & Poulin, P. A. (2019) · Evidence Based Mental Health · doi:10.1136/ebmental-2018-300062 · Cited by 175
Spinelli, C., Wisener, M., & Khoury, B. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.03.003 · Cited by 170
Mindfulness-based stress reduction for women diagnosed with breast cancer
Schell, L. K., Monsef, I., Wöckel, A., & Skoetz, N. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011518.pub2 · Cited by 168
Strohmaier, S. (2020) · Mindfulness · doi:10.1007/s12671-020-01319-4 · Cited by 163 · cited 1×
“The confluence of hundreds of RCTs testing MBIs (Strohmaier, 2020) with ongoing criticism of the evidence base highlights the need for a comprehensive and systematic evaluation of this literature.”
BackgroundSanada, K., Montero-Marin, J., Alda Díez, M., Salas-Valero, M., Pérez-Yus, M. C., Morillo, H., Demarzo, M. M. P., García-Toro, M., & García-Campayo, J. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00471 · Cited by 161
Pereira, T. V., & Ioannidis, J. P. A. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.12.012 · Cited by 160 · cited 1×
“…of four studies for effect sizes to be included resulted in some estimates being based on only four studies (and likely less reliable as a result; Pereira & Ioannidis, 2011) and other estimates being excluded because of an insufficient number of available studies (and therefore not represented…”
ResultSegal, Z. V., Dimidjian, S., Beck, A., Boggs, J. M., Vanderkruik, R., Metcalf, C. A., Gallop, R., Felder, J. N., & Levy, J. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.4693 · Cited by 159 · cited 1×
“Extensive experimental research has examined the effects of MBIs, including through large-scale RCTs (Kuyken et al., 2015; Segal et al., 2020).”
BackgroundThe efficacy of mindfulness-based interventions in primary care: a meta-analytic review.
Demarzo, M. M. P., Montero-Marin, J., Cuijpers, P., Zabaleta-del-Olmo, E., Mahtani, K. R., Vellinga, A., Vicens, C., Lopez-del-Hoyo, Y., & Garcia-Campayo, J. (2015) · The Annals of Family Medicine · doi:10.1370/afm.1863 · Cited by 152
Methods for second order meta-analysis and illustrative applications
Schmidt, F. L., & Oh, I.-S. (2013) · Organizational Behavior and Human Decision Processes · doi:10.1016/j.obhdp.2013.03.002 · Cited by 151 · cited 3×
“In the absence of second-order meta-analysis (Schmidt & Oh, 2013), we could not evaluate sources of this variability directly.”
BackgroundMethodInfluentialPhillips, E. A., Gordeev, V. S., & Schreyögg, J. (2019) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.3839 · Cited by 148
Li, S. Y. H., & Bressington, D. (2019) · International Journal of Mental Health Nursing · doi:10.1111/inm.12568 · Cited by 142 · cited 1×
“…cases, the meta-analytic estimates were based on five or fewer RCTs. Depending on the degree of heterogeneity (which in some cases was high, e.g., Li & Bressington, 2019), such tests are very likely underpowered to detect even moderate effects (e.g., post hoc power to detect d = 0.74 in Li and…”
BackgroundInfluentialWaldron, E. M., Hong, S., Moskowitz, J. T., & Burnett-Zeigler, I. (2018) · Mindfulness · doi:10.1007/s12671-018-0920-5 · Cited by 137 · cited 1×
“One especially troubling gap is a lack of primary studies and meta-analyses focused on the efficacy of MBIs for underserved and underrepresented groups (Waldron et al., 2018), which limits the generalizability of our results to these populations.”
BackgroundWhen mindfulness is therapy: Ethical qualms, historical perspectives.
Harrington, A., & Dunne, J. D. (2015) · American Psychologist · doi:10.1037/a0039460 · Cited by 135 · cited 1×
“Although mindfulness meditation was not originally developed to treat illness (Harrington & Dunne, 2015), MBIs have been used for the treatment of various psychiatric disorders (e.g., mindfulnessbased cognitive therapy for depression; Segal et al., 2013) and physical health conditions (e.g.,…”
MethodZhang, J., Xu, R., Wang, B., & Wang, J. (2016) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2016.02.012 · Cited by 130
Effects of Mindfulness-Based Interventions on Alexithymia: A Systematic Review
Norman, H., Marzano, L., Coulson, M., & Oskis, A. (2019) · Evidence Based Mental Health · doi:10.1136/ebmental-2018-300029 · Cited by 128
Is mindfulness research methodology improving over time? A systematic review
Goldberg, S. B., Tucker, R. P., Greene, P. A., Simpson, T. L., Kearney, D. J., & Davidson, R. J. (2017) · PLOS ONE · doi:10.1371/journal.pone.0187298 · Cited by 125 · cited 3×
“In keeping with concerns regarding small sample sizes in RCTs testing MBIs (Baer, 2003; Goldberg et al., 2017), it appears that many meta-analyses are also underpowered.”
BackgroundSelf-citationHalladay, J. E., Dawdy, J. L., McNamara, I. F., Chen, A. J., Vitoroulis, I., McInnes, N., & Munn, C. (2019) · Mindfulness · doi:10.1007/s12671-018-0979-z · Cited by 124
Minami, T., Wampold, B. E., Serlin, R. C., Hamilton, E. G., Brown, G. S. (., & Kircher, J. C. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.1.116 · Cited by 120 · cited 1×
“Nonetheless, presumably because of the improvements experienced by patients (Minami et al., 2008), cognitive behavioral therapy and other psychotherapies are widely perceived as efficacious by the research community and general public, recommended by providers, and paid for by managed care…”
BackgroundThe relationship between mindfulness and objective measures of body awareness: A meta-analysis
Treves, I. N., Tello, L. Y., Davidson, R. J., & Goldberg, S. B. (2019) · Scientific Reports · doi:10.1038/s41598-019-53978-6 · Cited by 114
Self-citationCoronado-Montoya, S., Levis, A. W., Kwakkenbos, L., Steele, R. J., Turner, E. H., & Thombs, B. D. (2016) · PLOS ONE · doi:10.1371/journal.pone.0153220 · Cited by 107 · cited 1×
“Other concerns raised with the MBI evidence base include an overreporting of trials demonstrating statistically significant effects (Coronado-Montoya et al., 2016), limitations associated with a reliance on self-report measures (especially of mindfulness itself; Davidson & Kaszniak, 2015; Grossman, 2008), and a host o…”
Backgroundde Abreu Costa, M., D’Alò de Oliveira, G. S., Tatton-Ramos, T., Manfro, G. G., & Salum, G. A. (2019) · Mindfulness · doi:10.1007/s12671-018-1058-1 · Cited by 85
Galante, J., Iribarren, S. J., & Pearce, P. F. (2013) · Journal of Research in Nursing · doi:10.1177/1744987112466087 · Cited by 79
Anheyer, D., Leach, M. J., Klose, P., Dobos, G., & Cramer, H. (2019) · Cephalalgia · doi:10.1177/0333102418781795 · Cited by 76
Wang, Y. Y., Li, X., Zheng, W., Xu, Z., Ng, C. H., Ungvari, G. S., Yuan, Z., & Xiang, Y. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.12.093 · Cited by 73
Hedman-Lagerlöf, M., Hedman-Lagerlöf, E., & Öst, L.-G. (2018) · Psychological Medicine · doi:10.1017/s0033291718000259 · Cited by 61
Lenz, A. S., Hall, J., & Smith, L. B. (2015) · The Journal for Specialists in Group Work · doi:10.1080/01933922.2015.1111488 · Cited by 56
Goldberg, S. B., Tucker, R. P., Greene, P. A., Simpson, T. L., Hoyt, W. T., Kearney, D. J., & Davidson, R. J. (2018) · Mindfulness · doi:10.1007/s12671-018-1032-y · Cited by 51
Self-citationOpportunistic biases: Their origins, effects, and an integrated solution.
DeCoster, J., Sparks, E., Sparks, J. C., Sparks, G. G., & Sparks, C. W. (2015) · American Psychologist · doi:10.1037/a0039191 · Cited by 49 · cited 1×
“As is increasingly discussed, selective reporting in particular allows opportunistic bias and can substantially reduce the scientific integrity of a body of literature (DeCoster et al., 2015).”
BackgroundWhat is mindfulness-based therapy good for?
Farias, M., Wikholm, C., & Delmonte, R. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30211-5 · Cited by 43 · cited 1×
“Because of these concerns, some researchers have questioned whether evidence actually supports beneficial effects of these practices and, if so, for whom (Farias et al., 2016).”
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Allegiance effects in mindfulness-based interventions for psychiatric disorders: A meta-re-analysis
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“However, even for these comparisons, it is crucial that researcher allegiance to MBIs be balanced with allegiance to the comparison condition (Goldberg & Tucker, 2020; Munder et al., 2013).”
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Cited by
Sorted by citations
Goldberg, S. B., Lam, S. U., Simonsson, O., Torous, J., & Sun, S. (2022) · PLOS Digital Health · doi:10.1371/journal.pdig.0000002 · Cited by 237
“, interventions tested using more rigorous specific active control conditions appear less effective [35]).”
BackgroundSelf-citationMa, J., Zhao, D., Xu, N., & Yang, J. (2023) · EXPLORE · doi:10.1016/j.explore.2022.08.001 · Cited by 176
Phan, M. L., Renshaw, T. L., Caramanico, J., Greeson, J. M., Mackenzie, E., Atkinson‐Diaz, Z., Doppelt, N., Tai, H., Mandell, D. S., & Nuske, H. J. (2022) · Mindfulness · doi:10.1007/s12671-022-01885-9 · Cited by 213
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“Third, although using an active control was a design strength, consistently recommended by mindfulness researchers (Goldberg et al., 2021), and ethically important during the pandemic, the lack of passive control hinders our knowledge on the ef fi cacy of both interventions in comparison to the…”
Self-citationPrevalence of meditation-related adverse effects in a population-based sample in the United States
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Self-citation
Metadata
- Authors
- Goldberg, S. B., Riordan, K. M., Sun, S., & Davidson, R. J.
- Affiliations
- University of Wisconsin–Madison (US)
- Brown University (US)
- Corresponding author
- Goldberg, Simon B.
- Venue
- Perspectives on Psychological Science
- Publisher
- SAGE Publications
- Published
- 2021-02-16
- Volume
- 17
- Issue
- 1
- Pages
- 108-130
- ISSN
- 1745-6916 (ISSN-L)
- 1745-6924
- PMC
- PMC8364929
- OpenAlex
- W3132572579
- Cited by
- 520
- References
- 111
- Citations by year
- 2026: 117 · 2025: 120 · 2024: 102 · 2023: 101 · 2022: 53 · 2021: 26
- FWCI
- 9.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Perspectives on Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH43454, T32MH078788)
- National Center for Complementary and Integrative Health (K23AT010879, P01AT004952)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- mindfulness-based interventions, effect size, passive control, active control, evidence-based treatment, publication bias, risk of bias, adverse effects, statistical power, heterogeneity, moderators
- MeSH terms
- Humans, Bias, Randomized Controlled Trials as Topic, Mindfulness
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