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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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In the citing paper
“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
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
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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BackgroundPower failure: why small sample size undermines the reliability of neuroscience
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“In addition, similar to recent evaluations of statistical power in neuroscience (Button et al., 2013), we also sought to assess the statistical power of meta-analyses conducted in this area.”
Background
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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
Sun, S., Lin, D., Goldberg, S., Shen, Z., Chen, P., Qiao, S., Brewer, J., Loucks, E., & Operario, D. (2022) · Journal of Counseling Psychology · doi:10.1037/cou0000568 · Cited by 138
“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
Goldberg, S. B., Lam, S. U., Britton, W. B., & Davidson, R. J. (2022) · Psychotherapy Research · doi:10.1080/10503307.2021.1933646 · Cited by 115
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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