Towards therapeutic paths in Post-Traumatic Stress Disorder: Systematic review and meta-analysis of mindfulness meditation-based and psychedelics assisted psychotherapies

Post-traumatic stress disorder (PTSD) remains a global health concern, yet many patients do not respond fully to existing treatments. Mindfulness meditation–based interventions (MMBIs) and psychedelic-assisted psychotherapies (PAP) have emerged as promising alternatives, though their comparative efficacy is not well understood. Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, and EBSCOhost for randomized controlled trials (RCTs) published through January 2024. We included trials reporting post-treatment changes in validated PTSD symptom measures, focusing on two intervention categories: MMBIs (n=13 RCTs) and PAP (n=9 RCTs). Standardized mean differences (SMD) were calculated under a random-effects model, with 95% confidence intervals (CIs). MMBIs produced a significant, moderate effect on PTSD symptoms (SMD=0.45, 95% CI [0.27, 0.63]; p<0.001). PAP also demonstrated a moderate effect size (SMD=0.54, 95% CI [0.32, 0.76]; p<0.001), with MDMA displaying slightly stronger outcomes than ketamine. PAP studies generally showed tighter confidence intervals and lower risk of bias compared to MMBI trials. Heterogeneity varied, but subgroup analyses indicated consistent effects across intervention types. In conclusion, both MMBIs and PAP are efficacious in reducing PTSD symptoms among adults. While PAP appears to yield a marginally larger effect size, MMBIs offer practical advantages due to ease of dissemination. Future research should address long-term efficacy, adverse events, and culturally diverse populations. The role of altered states of consciousness in both interventions also warrant closer investigation, potentially illuminating mechanisms underlying therapeutic gains.